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Predicting Functional Outcome One Year After Traumatic Brain Injury With CT and MRI Findings
Abstract
Methods: This study was a prospective, population-based study of 87 patients with a Glasgow Coma Scale (GCS) score ≤ 12 who were injured in 2005 - 2007 and hospitalized at Trauma Referral Centre in Eastern Norway. CT performed within 24 h post-injury was classified by Marshall classification scale. MRI performed one year post-injury was classified based on the presence or absence of diffuse axonal injuries (DAIs). The Glasgow Outcome Scale Extended (GOSE) was used as an outcome measure at the one-year follow-up. The predictions models were adjusted for clinical variables known to affect functional outcome.
Results: Using CT, small lesions (Marshall group 2) were observed in 37 (42%) patients. Signs of increased intracranial pressure (Marshall groups 3 - 4) were present in 33 (38%) patients. Using MRI, DAI lesions were found in 70% of patients. In the linear regression analysis that explored relative impact of CT, CT was a significant predictor of GOSE (p < 0.001). In the model exploring combined impact of CT and MRI, MRI accounted for a larger proportion of variance in GOSE and appears as stronger predictor (p < 0.001) than CT (p = 0.08).
Conclusions: The relative impact of CT findings of intracranial lesions in the acute settings and one-year MRI findings of DAI on functional outcome underscored the importance of using neuroimaging techniques when predicting functional outcomes after TBI. The better predictive value of MRI suggest that the detailed information about pathological brain lesions shown on late MR may help clinicians to administer more appropriate rehabilitation treatments to patients who are predicted to have a worse outcome at the one-year follow-up.
J Neurol Res. 2012;2(4):134-144
doi: https://doi.org/10.4021/jnr133w