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Perfusion Abnormalities are Frequently Detected by Early CT Perfusion and Predict Unfavourable Outcome Following Severe Traumatic Brain Injury

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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 large-scale studies.

Level of evidence III

Prospective study.

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Authors’ Contributions

CB contributed to the study design, writing, and literature search; SC contributed to the data collection and interpretation; TE contributed to the statistical analysis; AB contributed to the data interpretation; DP contributed to functional outcome data acquisition; MP contributed to the study design, writing, and critical revision; and ZB contributed to the study design, writing, and critical revision.

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Authors and Affiliations

  1. Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia

    Cino Bendinelli, Shannon Cooper & Zsolt J. Balogh

  2. Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia

    Andrew Bivard & Mark Parson

  3. Department of Rehabilitation, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia

    Dianne Pacey

  4. Clinical Research Design, Information Technology and Statistical Support, Hunter Medical Research Institute, Newcastle, NSW, Australia

    Tiffany Evans

Authors
  1. Cino Bendinelli
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  2. Shannon Cooper
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  3. Tiffany Evans
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  7. Zsolt J. Balogh
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Correspondence to Zsolt J. Balogh.

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Bendinelli, C., Cooper, S., Evans, T. et al. Perfusion Abnormalities are Frequently Detected by Early CT Perfusion and Predict Unfavourable Outcome Following Severe Traumatic Brain Injury. World J Surg 41, 2512–2520 (2017). https://doi.org/10.1007/s00268-017-4030-7

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  • DOI: https://doi.org/10.1007/s00268-017-4030-7

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