- Title
- Perfusion abnormalities are frequently detected by early CT perfusion and predict unfavourable outcome following severe traumatic brain injury
- Creator
- Bendinelli, Cino; Cooper, Shannon; Evans, Tiffany; Bivard, Andrew; Pacey, Dianne; Parson, Mark; Balogh, Zsolt J.
- Relation
- World Journal of Surgery Vol. 41, Issue 10, p. 2512-2520
- Publisher Link
- http://dx.doi.org/10.1007/s00268-017-4030-7
- Publisher
- Springer
- Resource Type
- journal article
- Date
- 2017
- Description
- Background: In patients with severe traumatic brain injury (TBI), early CT perfusion (CTP) provides additional information beyond the non-contrast CT (NCCT) and may alter clinical management. We hypothesized that this information may prognosticate functional outcome. Methods: Five-year prospective observational study was performed in a level-1 trauma centre on consecutive severe TBI patients. CTP (obtained in conjunction with first routine NCCT) was interpreted as: abnormal, area of altered perfusion more extensive than on NCCT, and the presence of ischaemia. Six months Glasgow Outcome Scale-Extended of four or less was considered an unfavourable outcome. Logistic regression analysis of CTP findings and core variables [preintubation Glasgow Coma Scale (GCS), Rotterdam score, base deficit, age] was conducted using Bayesian model averaging to identify the best predicting model for unfavourable outcome. Results: Fifty patients were investigated with CTP (one excluded for the absence of TBI) [male: 80%, median age: 35 (23-55), prehospital intubation: 7 (14.2%); median GCS: 5 (3-7); median injury severity score: 29 (20-36); median head and neck abbreviated injury scale: 4 (4-5); median days in ICU: 10 (5-15)] . Thirty (50.8%) patients had an unfavourable outcome. GCS was a moderate predictor of unfavourable outcome (AUC = 0.74), while CTP variables showed greater predictive ability (AUC for abnormal CTP = 0.92; AUC for area of altered perfusion more extensive than NCCT = 0.83; AUC for the presence of ischaemia = 0.81). Conclusion: Following severe TBI, CTP performed at the time of the first follow-up NCCT, is a non-invasive and extremely valuable tool for early outcome prediction. The potential impact on management and its cost effectiveness deserves to be evaluated in la rge-scale studies. Level of evidence III: Prospective study.
- Subject
- severe traumatic brain injury; traumatic brain injury; early CT perfusion; clinical management; observational study
- Identifier
- http://hdl.handle.net/1959.13/1396718
- Identifier
- uon:34105
- Identifier
- ISSN:0364-2313
- Language
- eng
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