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Prognostic Value of Hemorrhagic Brainstem Injury on Early Computed Tomography: A TRACK-TBI Study.

Publication ,  Journal Article
Williams, JR; Nieblas-Bedolla, E; Feroze, A; Young, C; Temkin, NR; Giacino, JT; Okonkwo, DO; Manley, GT; Barber, J; Durfy, S; Markowitz, AJ ...
Published in: Neurocrit Care
October 2021

BACKGROUND: Traumatic brainstem injury has yet to be incorporated into widely used imaging classification systems for traumatic brain injury (TBI), and questions remain regarding prognostic implications for this TBI subgroup. To address this, retrospective data on patients from the multicenter prospective Transforming Research and Clinical Knowledge in TBI study were studied. METHODS: Patients with brainstem and cerebrum injury (BSI+) were matched by age, sex, and admission Glasgow Coma Scale (GCS) score to patients with cerebrum injuries only. All patients had an interpretable head computed tomography (CT) scan from the first 48 hours after injury and a 6-month Glasgow Outcome Scale Extended (GOSE) score. CT scans were reviewed for brainstem lesions and, when present, characterized by location, size, and type (traumatic axonal injury, contusion, or Duret hemorrhage). Clinical, demographic, and outcome data were then compared between the two groups. RESULTS: Mann-Whitney U-tests showed no significant difference in 6-month GOSE scores in patients with BSI+ (mean 2.7) compared with patients with similar but only cerebrum injuries (mean 3.9), although there is a trend (p = 0.10). However, subclassification by brainstem lesion type, traumatic axonal injury (mean 4.0) versus Duret hemorrhage or contusion (mean 1.4), did identify a proportion of BSI+ with significantly less favorable outcome (p = 0.002). The incorporation of brainstem lesion type (traumatic axonal injury vs. contusion/Duret), along with GCS into a multivariate logistic regression model of favorable outcome (GOSE score 4-8) did show a significant contribution to the prognostication of this brainstem injury subgroup (odds ratio 0.08, 95% confidence interval 0.00-0.67, p = 0.01). CONCLUSIONS: These findings suggest two groups of patients with brainstem injuries may exist with divergent recovery potential after TBI. These data support the notion that newer CT imaging classification systems may augment traditional clinical measures, such as GCS in identifying those patients with TBI and brainstem injuries that stand a higher chance of favorable outcome.

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Published In

Neurocrit Care

DOI

EISSN

1556-0961

Publication Date

October 2021

Volume

35

Issue

2

Start / End Page

335 / 346

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Retrospective Studies
  • Prospective Studies
  • Prognosis
  • Neurology & Neurosurgery
  • Humans
  • Glasgow Coma Scale
  • Brain Stem
  • Brain Injuries, Traumatic
  • 4205 Nursing
 

Citation

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Williams, J. R., Nieblas-Bedolla, E., Feroze, A., Young, C., Temkin, N. R., Giacino, J. T., … and The Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Investigators. (2021). Prognostic Value of Hemorrhagic Brainstem Injury on Early Computed Tomography: A TRACK-TBI Study. Neurocrit Care, 35(2), 335–346. https://doi.org/10.1007/s12028-021-01263-8
Williams, John R., Edwin Nieblas-Bedolla, Abdullah Feroze, Christopher Young, Nancy R. Temkin, Joseph T. Giacino, David O. Okonkwo, et al. “Prognostic Value of Hemorrhagic Brainstem Injury on Early Computed Tomography: A TRACK-TBI Study.Neurocrit Care 35, no. 2 (October 2021): 335–46. https://doi.org/10.1007/s12028-021-01263-8.
Williams JR, Nieblas-Bedolla E, Feroze A, Young C, Temkin NR, Giacino JT, et al. Prognostic Value of Hemorrhagic Brainstem Injury on Early Computed Tomography: A TRACK-TBI Study. Neurocrit Care. 2021 Oct;35(2):335–46.
Williams, John R., et al. “Prognostic Value of Hemorrhagic Brainstem Injury on Early Computed Tomography: A TRACK-TBI Study.Neurocrit Care, vol. 35, no. 2, Oct. 2021, pp. 335–46. Pubmed, doi:10.1007/s12028-021-01263-8.
Williams JR, Nieblas-Bedolla E, Feroze A, Young C, Temkin NR, Giacino JT, Okonkwo DO, Manley GT, Barber J, Durfy S, Markowitz AJ, Yuh EL, Mukherjee P, Mac Donald CL, and The Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Investigators. Prognostic Value of Hemorrhagic Brainstem Injury on Early Computed Tomography: A TRACK-TBI Study. Neurocrit Care. 2021 Oct;35(2):335–346.
Journal cover image

Published In

Neurocrit Care

DOI

EISSN

1556-0961

Publication Date

October 2021

Volume

35

Issue

2

Start / End Page

335 / 346

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Retrospective Studies
  • Prospective Studies
  • Prognosis
  • Neurology & Neurosurgery
  • Humans
  • Glasgow Coma Scale
  • Brain Stem
  • Brain Injuries, Traumatic
  • 4205 Nursing