Head CT findings offer window into recovery after concussion

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By Reuters Staff

NEW YORK (Reuters Health) - Different patterns of brain injury on head computed tomography (CT) correlate with prognosis after mild traumatic brain injury (mTBI), according to a new study.

In cases of moderate to severe TBI (Glasgow Coma Scale scores 3-12), some CT features have been shown to correlate with outcomes. But in mTBI (GCS scores 13-15), the distribution and co-occurrence of pathological CT features and their prognostic importance are not well understood, researchers explain in JAMA Neurology.

To investigate, Dr. Esther Yuh of the University of California, San Francisco, and colleagues analyzed the CT scans of 1,935 patients (mean age, 42 years, 67% men) with mTBI enrolled in the TRACK-TBI study as well as 2,594 mTBI patients (mean age, 52 years; 64% men) from the CENTER-TBI study (external validation cohort). All patients were assessed at two weeks, and at three-, six- and 12 months after injury.

"There was striking replication of results across TRACK-TBI and CENTER-TBI," the researchers report.

In both studies, contusion, subarachnoid hemorrhage (SAH), and subdural hematoma (SDH) often co-occurred and were strongly associated with adverse outcomes over a broad range of Glasgow Outcome Scale-Extended (GOSE) scores up 12 months after injury.

Both studies also showed that intraventricular and/or petechial hemorrhage was associated with greater degrees of unfavorable outcome (GOSE scores <5) up 12 months after mTBI.

Epidural hemorrhage was associated with incomplete recovery (GOSE scores <8 vs. 8) at three months in TRACK- TBI and 12 months in CENTER-TBI, but had no significant association with greater degrees of unfavorable outcome at any point in either study.

Some intracranial hemorrhage patterns were more strongly associated with outcomes than validated demographic and clinical variables, the researchers say.

They also note that the study population was enriched for "complicated" mTBI and this enrichment provided "sufficient power to determine the prognostic importance of CT abnormalities at a more granular level than simply positive vs negative categories."

"These more granular CT findings can immediately aid in the triage to TBI-specific education and systematic follow-up of the nearly 5 million patients with mTBI evaluated annually in U.S. emergency departments," they say.

Other recently reported data from the TRACK-TBI study show that long-term prognosis for some patients with moderate to severe TBI are better than expected and argue against making decisions about life-sustaining treatment in the early days after injury, the researchers say.

Dr. Geoffrey Manley, also of UCSF, and colleagues followed 484 TRACK-TBI patients with moderate-to-severe TBI. They found that one in four patients who were in a vegetative state "regained orientation" - meaning they knew who they were, their location and the date - within 12 months of their injury.

"Withdrawal of life-sustaining treatment based on early prediction of poor outcome accounts for most deaths in patients hospitalized with severe TBI," Dr. Manley said in a statement, noting that 64 of the 92 deaths in the study cohort occurred within two weeks of injury.

"TBI is a life-changing event that can produce significant, lasting disability, and there are cases when it is very clear early on that a patient will not recover," Dr. Manley said. "But results from this study show a significant proportion of our participants experienced major improvements in life functioning, with many regaining independence between two weeks and 12 months after injury."

SOURCE: https://bit.ly/3hS9PiT and https://bit.ly/3kBOhJ1 JAMA Neurology, online July 6 and July 19, 2021.

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