Hourmazd Haghbayan1,2, Amélie Boutin1, Mathieu Laflamme1,3, François Lauzier1,3,4, Michèle Shemilt1, Lynne Moore1,5, Ryan Zarychanski6,7, Vincent Douville1, Dean Fergusson8, Alexis F Turgeon1,4. 1. CHU de Québec - Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec, QC, Canada. 2. Department of Medicine, University of Toronto, Toronto, ON, Canada. 3. Department of Medicine, Université Laval, Québec, QC, Canada. 4. Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, QC, Canada. 5. Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada. 6. George and Fay Yee Centre for Healthcare Innovation, Knowledge Synthesis, Winnipeg, MB, Canada. 7. CancerCare Manitoba, Department of Haematology and Medical Oncology, University of Manitoba, Winnipeg, MB, Canada. 8. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Abstract
OBJECTIVES: Traumatic brain injury is a major cause of death and disability, yet many predictors of outcome are not precise enough to guide initial clinical decision-making. Although increasingly used in the early phase following traumatic brain injury, the prognostic utility of MRI remains uncertain. We thus undertook a systematic review and meta-analysis of studies evaluating the predictive value of acute MRI lesion patterns for discriminating clinical outcome in traumatic brain injury. DATA SOURCES: MEDLINE, EMBASE, BIOSIS, and CENTRAL from inception to November 2015. STUDY SELECTION: Studies of adults who had MRI in the acute phase following moderate or severe traumatic brain injury. Our primary outcomes were all-cause mortality and the Glasgow Outcome Scale. DATA EXTRACTION: Two authors independently performed study selection and data extraction. We calculated pooled effect estimates with a random effects model, evaluated the risk of bias using a modified version of Quality in Prognostic Studies and determined the strength of evidence with the Grading of Recommendations, Assessment, Development, and Evaluation. DATA SYNTHESIS: We included 58 eligible studies, of which 27 (n = 1,652) contributed data to meta-analysis. Brainstem lesions were associated with all-cause mortality (risk ratio, 1.78; 95% CI, 1.01-3.15; I = 43%) and unfavorable Glasgow Outcome Scale (risk ratio, 2.49; 95% CI, 1.72-3.58; I = 81%) at greater than or equal to 6 months. Diffuse axonal injury patterns were associated with an increased risk of unfavorable Glasgow Outcome Scale (risk ratio, 2.46; 95% CI, 1.06-5.69; I = 74%). MRI scores based on lesion depth demonstrated increasing risk of unfavorable neurologic outcome as more caudal structures were affected. Most studies were at high risk of methodological bias. CONCLUSIONS: MRI following traumatic brain injury yields important prognostic information, with several lesion patterns significantly associated with long-term survival and neurologic outcome. Given the high risk of bias in the current body of literature, large well-controlled studies are necessary to better quantify the prognostic role of early MRI in moderate and severe traumatic brain injury.
OBJECTIVES:Traumatic brain injury is a major cause of death and disability, yet many predictors of outcome are not precise enough to guide initial clinical decision-making. Although increasingly used in the early phase following traumatic brain injury, the prognostic utility of MRI remains uncertain. We thus undertook a systematic review and meta-analysis of studies evaluating the predictive value of acute MRI lesion patterns for discriminating clinical outcome in traumatic brain injury. DATA SOURCES: MEDLINE, EMBASE, BIOSIS, and CENTRAL from inception to November 2015. STUDY SELECTION: Studies of adults who had MRI in the acute phase following moderate or severe traumatic brain injury. Our primary outcomes were all-cause mortality and the Glasgow Outcome Scale. DATA EXTRACTION: Two authors independently performed study selection and data extraction. We calculated pooled effect estimates with a random effects model, evaluated the risk of bias using a modified version of Quality in Prognostic Studies and determined the strength of evidence with the Grading of Recommendations, Assessment, Development, and Evaluation. DATA SYNTHESIS: We included 58 eligible studies, of which 27 (n = 1,652) contributed data to meta-analysis. Brainstem lesions were associated with all-cause mortality (risk ratio, 1.78; 95% CI, 1.01-3.15; I = 43%) and unfavorable Glasgow Outcome Scale (risk ratio, 2.49; 95% CI, 1.72-3.58; I = 81%) at greater than or equal to 6 months. Diffuse axonal injury patterns were associated with an increased risk of unfavorable Glasgow Outcome Scale (risk ratio, 2.46; 95% CI, 1.06-5.69; I = 74%). MRI scores based on lesion depth demonstrated increasing risk of unfavorable neurologic outcome as more caudal structures were affected. Most studies were at high risk of methodological bias. CONCLUSIONS: MRI following traumatic brain injury yields important prognostic information, with several lesion patterns significantly associated with long-term survival and neurologic outcome. Given the high risk of bias in the current body of literature, large well-controlled studies are necessary to better quantify the prognostic role of early MRI in moderate and severe traumatic brain injury.
Authors: Geert Meyfroidt; Pierre Bouzat; Michael P Casaer; Randall Chesnut; Sophie Rym Hamada; Raimund Helbok; Peter Hutchinson; Andrew I R Maas; Geoffrey Manley; David K Menon; Virginia F J Newcombe; Mauro Oddo; Chiara Robba; Lori Shutter; Martin Smith; Ewout W Steyerberg; Nino Stocchetti; Fabio Silvio Taccone; Lindsay Wilson; Elisa R Zanier; Giuseppe Citerio Journal: Intensive Care Med Date: 2022-05-20 Impact factor: 41.787
Authors: Alexander Olsen; Talin Babikian; Erin D Bigler; Karen Caeyenberghs; Virginia Conde; Kristen Dams-O'Connor; Ekaterina Dobryakova; Helen Genova; Jordan Grafman; Asta K Håberg; Ingrid Heggland; Torgeir Hellstrøm; Cooper B Hodges; Andrei Irimia; Ruchira M Jha; Paula K Johnson; Vassilis E Koliatsos; Harvey Levin; Lucia M Li; Hannah M Lindsey; Abigail Livny; Marianne Løvstad; John Medaglia; David K Menon; Stefania Mondello; Martin M Monti; Virginia F J Newcombe; Agustin Petroni; Jennie Ponsford; David Sharp; Gershon Spitz; Lars T Westlye; Paul M Thompson; Emily L Dennis; David F Tate; Elisabeth A Wilde; Frank G Hillary Journal: Brain Imaging Behav Date: 2021-04 Impact factor: 3.978