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dc.contributor.authorYuh, Esther
dc.contributor.authorJain, Sonia
dc.contributor.authorSun, Xiaoying
dc.contributor.authorPisică, Dana
dc.contributor.authorHarris, Mark H.
dc.contributor.authorTaylor, Sabrina R.
dc.contributor.authorMarkowitz, Amy J.
dc.contributor.authorMukherjee, Pratik
dc.contributor.authorVerheyden, Jan
dc.contributor.authorGiacino, Joseph T.
dc.contributor.authorLevin, Harvey
dc.contributor.authorMcCrea, Michael
dc.contributor.authorStein, Murray B.
dc.contributor.authorTemkin, Nancy R
dc.contributor.authorDiaz-Arrastia, Ramon
dc.contributor.authorRobertson, Claudia
dc.contributor.authorLingsma, Hester F.
dc.contributor.authorOkonkwo, David O.
dc.contributor.authorMaas, Andrew I. R.
dc.contributor.authorManley, Geoffrey T.
dc.contributor.authorAndelic, Nada
dc.contributor.authorAndreassen, Lasse
dc.contributor.authorAnke, Audny Gabriele Wagner
dc.contributor.authorFrisvold, Shirin
dc.contributor.authorHelseth, Eirik
dc.contributor.authorRøe, Cecilie
dc.contributor.authorRøise, Olav
dc.contributor.authorSkandsen, Toril
dc.contributor.authorVik, Anne
dc.contributor.authorÅkerlund, Cecilia
dc.contributor.authorAmrein, Krisztina
dc.contributor.authorAntoni, Anna
dc.contributor.authorAudibert, Gerard
dc.contributor.authorAzouvi, Philippe
dc.contributor.authorAzzolini, Maria luisa
dc.contributor.authorBartels, Ronald
dc.contributor.authorBarzo, Pal
dc.contributor.authorBeauvais, Romuald
dc.contributor.authorBeer, Ronny
dc.contributor.authorBellander, Bo-michael
dc.contributor.authorBelli, Antonio
dc.contributor.authorBenali, Habib
dc.contributor.authorBerardino, Maurizio
dc.contributor.authorBeretta, Luigi
dc.contributor.authorBlaabjerg, Morten
dc.contributor.authorBragge, Peter
dc.contributor.authorBrazinova, Alexandra
dc.contributor.authorBrinck, Vibeke
dc.contributor.authorBrooker, Joanne
dc.contributor.authorBrorsson, Camilla
dc.contributor.authorBuki, Andras
dc.contributor.authorBullinger, Monika
dc.contributor.authorCabeleira, Manuel
dc.contributor.authorCaccioppola, Alessio
dc.contributor.authorCalappi, Emiliana
dc.contributor.authorCalvi, Maria rosa
dc.identifier.citationJAMA Neurology. 2021, 78 (9), 1137-1148.en_US
dc.description.abstractImportance A head computed tomography (CT) with positive results for acute intracranial hemorrhage is the gold-standard diagnostic biomarker for acute traumatic brain injury (TBI). In moderate to severe TBI (Glasgow Coma Scale [GCS] scores 3-12), some CT features have been shown to be associated with outcomes. In mild TBI (mTBI; GCS scores 13-15), distribution and co-occurrence of pathological CT features and their prognostic importance are not well understood. Objective To identify pathological CT features associated with adverse outcomes after mTBI. Design, Setting, and Participants The longitudinal, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study enrolled patients with TBI, including those 17 years and older with GCS scores of 13 to 15 who presented to emergency departments at 18 US level 1 trauma centers between February 26, 2014, and August 8, 2018, and underwent head CT imaging within 24 hours of TBI. Evaluations of CT imaging used TBI Common Data Elements. Glasgow Outcome Scale–Extended (GOSE) scores were assessed at 2 weeks and 3, 6, and 12 months postinjury. External validation of results was performed via the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Data analyses were completed from February 2020 to February 2021. Exposures Acute nonpenetrating head trauma. Main Outcomes and Measures Frequency, co-occurrence, and clustering of CT features; incomplete recovery (GOSE scores <8 vs 8); and an unfavorable outcome (GOSE scores <5 vs ≥5) at 2 weeks and 3, 6, and 12 months. Results In 1935 patients with mTBI (mean [SD] age, 41.5 [17.6] years; 1286 men [66.5%]) in the TRACK-TBI cohort and 2594 patients with mTBI (mean [SD] age, 51.8 [20.3] years; 1658 men [63.9%]) in an external validation cohort, hierarchical cluster analysis identified 3 major clusters of CT features: contusion, subarachnoid hemorrhage, and/or subdural hematoma; intraventricular and/or petechial hemorrhage; and epidural hematoma. Contusion, subarachnoid hemorrhage, and/or subdural hematoma features were associated with incomplete recovery (odds ratios [ORs] for GOSE scores <8 at 1 year: TRACK-TBI, 1.80 [95% CI, 1.39-2.33]; CENTER-TBI, 2.73 [95% CI, 2.18-3.41]) and greater degrees of unfavorable outcomes (ORs for GOSE scores <5 at 1 year: TRACK-TBI, 3.23 [95% CI, 1.59-6.58]; CENTER-TBI, 1.68 [95% CI, 1.13-2.49]) out to 12 months after injury, but epidural hematoma was not. Intraventricular and/or petechial hemorrhage was associated with greater degrees of unfavorable outcomes up to 12 months after injury (eg, OR for GOSE scores <5 at 1 year in TRACK-TBI: 3.47 [95% CI, 1.66-7.26]). Some CT features were more strongly associated with outcomes than previously validated variables (eg, ORs for GOSE scores <5 at 1 year in TRACK-TBI: neuropsychiatric history, 1.43 [95% CI .98-2.10] vs contusion, subarachnoid hemorrhage, and/or subdural hematoma, 3.23 [95% CI 1.59-6.58]). Findings were externally validated in 2594 patients with mTBI enrolled in the CENTER-TBI study. Conclusions and Relevance In this study, pathological CT features carried different prognostic implications after mTBI to 1 year postinjury. Some patterns of injury were associated with worse outcomes than others. These results support that patients with mTBI and these CT features need TBI-specific education and systematic follow-up.en_US
dc.publisherAmerican Medical Associationen_US
dc.rightsNavngivelse 4.0 Internasjonal*
dc.titlePathological Computed Tomography Features Associated With Adverse Outcomes After Mild Traumatic Brain Injury: A TRACK-TBI Study With External Validation in CENTER-TBIen_US
dc.typePeer revieweden_US
dc.typeJournal articleen_US
dc.source.journalJAMA Neurologyen_US

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