Prognostic value of various intracranial pathologies in traumatic brain injury
- 140 Downloads
Various intracranial pathologies in traumatic brain injury (TBI) can help to predict patient outcomes. These pathologies can be categorised using the Marshall Classification or the Abbreviated Injury Scale (AIS) dictionary or can be described through traditional descriptive terms such as subarachnoid haemorrhage (SAH), subdural haemorrhage (SDH), epidural haemorrhage (EDH) etc. The purpose of this study is to assess the prognostic value of AIS scores, the Marshall Classification and various intracranial pathologies in TBI.
A dataset of 802 TBI patients in the Trauma Audit and Research Network (TARN) database was analysed using logistic regression. First, a baseline model was constructed with age, Glasgow Coma Scale (GCS), pupillary reactivity, cause of injury and presence/absence of extracranial injury as predictors and survival at discharge as the outcome. Subsequently, AIS score, the Marshall Classification and various intracranial pathologies such as haemorrhage, SAH or brain swelling were added in order to assess the relative predictive strength of each variable and also to assess the improvement in the performance of the model.
Various AIS scores or Marshal classes did not appear to significantly affect the outcome. Among traditional descriptive terms, only brain stem injury and brain swelling significantly influenced outcome [odds ratios for survival: 0.17 (95% confidence interval [CI]; 0.08–0.40) and 0.48 (95% CI; 0.29–0.80), respectively]. Neither haemorrhage nor its subtypes, such as SAH, SDH and EDH, were significantly associated with outcome. Adding AIS scores, the Marshall Classification and various intracranial pathologies to the prognostic models resulted in an almost equal increase in the predictive performance of the baseline model.
In this relatively recent dataset, each of the brain injury classification systems enhanced equally the performance of an early mortality prediction model in traumatic brain injury patients. The significant effect of brain swelling and brain stem injury on the outcome in comparison to injuries such as SAH suggests the need to improve therapeutic approaches to patients who have sustained these injuries.
KeywordsComputed tomography Traumatic brain injury Intracranial haemorrhage Outcome
We would like to thank the TARN members of staff and participating hospitals for the collection and submission of the data. This work was funded, in part, by the Trauma Audit and Research Network (TARN) and Overseas Research Students (ORS) Award Scheme, University of Manchester.
Conflict of interest
- 4.Servadei F, Murray GD, Teasdale GM, Dearden M, Iannotti F, Lapierre F, Maas AJ, Karimi A, Ohman J, Persson L, Stocchetti N, Trojanowski T, Unterberg A. Traumatic subarachnoid hemorrhage: demographic and clinical study of 750 patients from the European brain injury consortium survey of head injuries. Neurosurgery. 2002;50(2):261–7. Discussion 267–9.PubMedGoogle Scholar
- 5.Steyerberg EW, Mushkudiani N, Perel P, Butcher I, Lu J, McHugh GS, Murray GD, Marmarou A, Roberts I, Habbema JD, Maas AI. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med. 2008;5(8):e165. Discussion e165.PubMedCrossRefGoogle Scholar
- 6.Maas AI, Hukkelhoven CW, Marshall LF, Steyerberg EW. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery. 2005;57(6):1173–82. Discussion 1173–82.PubMedCrossRefGoogle Scholar
- 13.Servadei F, Murray GD, Penny K, Teasdale GM, Dearden M, Iannotti F, Lapierre F, Maas AJ, Karimi A, Ohman J, Persson L, Stocchetti N, Trojanowski T, Unterberg A. The value of the “worst” computed tomographic scan in clinical studies of moderate and severe head injury. European Brain Injury Consortium. Neurosurgery. 2000;46(1):70–5. Discussion 75–7.PubMedCrossRefGoogle Scholar
- 14.The Abbreviated Injury Scale, 1990 Revision, Update 98 Barrington, USA: Association for the Advancement of Automatic Medicine; 2001.Google Scholar
- 15.The Abbreviated Injury Scale, 2005, Update 2008 Barrington, USA: Association for the Advancement of Automatic Medicine; 2008.Google Scholar
- 17.The Trauma Audit and Research Network (TARN), Salford, UK. Home page at: http://www.tarn.ac.uk/. Accessed 13/08/2009.
- 18.MRC CRASH Trial Collaborators; Perel P, Arango M, Clayton T, Edwards P, Komolafe E, Poccock S, Roberts I, Shakur H, Steyerberg E, Yutthakasemsunt S. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ. 2008;336(7641):425–9.PubMedCrossRefGoogle Scholar
- 19.Marmarou A, Lu J, Butcher I, McHugh GS, Murray GD, Steyerberg EW, Mushkudiani NA, Choi S, Maas AI. Prognostic value of the Glasgow Coma Scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis. J Neurotrauma. 2007;24(2):270–80.PubMedCrossRefGoogle Scholar
- 23.Murray GD, Teasdale GM, Braakman R, Cohadon F, Dearden M, Iannotti F, Karimi A, Lapierre F, Maas A, Ohman J, Persson L, Servadei F, Stocchetti N, Trojanowski T, Unterberg A. The European Brain Injury Consortium survey of head injuries. Acta Neurochir (Wien). 1999;141(3):223–36.CrossRefGoogle Scholar