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Comparative Study
. 2013 Feb;73(2):224-35.
doi: 10.1002/ana.23783. Epub 2012 Dec 7.

Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury

Esther L Yuh  1 , Pratik Mukherjee, Hester F Lingsma, John K Yue, Adam R Ferguson, Wayne A Gordon, Alex B Valadka, David M Schnyer, David O Okonkwo, Andrew I R Maas, Geoffrey T Manley; TRACK-TBI Investigators
Collaborators, Affiliations
Comparative Study

Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury

Esther L Yuh et al. Ann Neurol. 2013 Feb.

Abstract

Objective: To determine the clinical relevance, if any, of traumatic intracranial findings on early head computed tomography (CT) and brain magnetic resonance imaging (MRI) to 3-month outcome in mild traumatic brain injury (MTBI).

Methods: One hundred thirty-five MTBI patients evaluated for acute head injury in emergency departments of 3 LEVEL I trauma centers were enrolled prospectively. In addition to admission head CT, early brain MRI was performed 12 ± 3.9 days after injury. Univariate and multivariate logistic regression were used to assess for demographic, clinical, socioeconomic, CT, and MRI features that were predictive of Extended Glasgow Outcome Scale (GOS-E) at 3 months postinjury.

Results: Twenty-seven percent of MTBI patients with normal admission head CT had abnormal early brain MRI. CT evidence of subarachnoid hemorrhage was associated with a multivariate odds ratio of 3.5 (p = 0.01) for poorer 3-month outcome, after adjusting for demographic, clinical, and socioeconomic factors. One or more brain contusions on MRI, and ≥4 foci of hemorrhagic axonal injury on MRI, were each independently associated with poorer 3-month outcome, with multivariate odds ratios of 4.5 (p = 0.01) and 3.2 (p = 0.03), respectively, after adjusting for head CT findings and demographic, clinical, and socioeconomic factors.

Interpretation: In this prospective multicenter observational study, the clinical relevance of abnormal findings on early brain imaging after MTBI is demonstrated. The addition of early CT and MRI markers to a prognostic model based on previously known demographic, clinical, and socioeconomic predictors resulted in a >2-fold increase in the explained variance in 3-month GOS-E.

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