Outcome Of Severe Disability Research Articles

Posttraumatic Amnesia: A Systematic Review and Meta-Analysis. Proposal for a New Severity Classification

Posttraumatic amnesia (PTA) duration is used to predict outcome after traumatic brain injury (TBI): however, no meta-analysis exists. A systematic review was performed following PRISMA reporting guidelines. The databases Scopus-1966, PubMed/MEDLINE, CINAHL, PsycINFO, and Embase were searched for relevant texts. Random effects meta-analysis derived pooled estimates of the odds ratio of outcomes of interest and sensitivity and specificity of PTA at different cutoffs, and subsequently a summary receiver operating curve was derived. PTA prediction of Glasgow Outcome Scale (GOS) and Glasgow Outcome Scale-Extended (GOSE) scores was assessed both qualitatively and quantitatively by pooled odds ratio regarding both a good outcome (GO: GOS-5 or GOSE-7/GOSE-8) and a severe disability outcome (SDO: GOS-3 or a GOSE-3/GOSE-4). Summary receiver operating curve analysis was performed in the prediction of composite of a moderate disability outcome (MDO: GOS-4 or GOSE-5/GOSE-6) and SDO. Twenty-four studies were included in qualitative synthesis, and 9 (12,386 patients; males, 64%-84%) in meta-analysis. The odds of a GO and SDO were significantly different between PTA >56 days and PTA <7 days (P= 0.04 and P= 0.03). PTA <7 days (mild TBI) excluded MDO/SDO and SDO alone with 87% and 90% sensitivity. PTA of 43-86 days (severe TBI) predicted MDO/SDO or SDO with 90%-96% and 80%-90% specificity. However, PTA of 7-42 days (moderate TBI) predicted MDO/SDO or SDO with only 38%-89% and 30%-80% specificity. PTA duration was reliable in predicting outcome when <7 days, and especially when >42 days but was often unreliable between 7 and 42 days duration.

Regional brain morphometry in patients with traumatic brain injury based on acute- and chronic-phase magnetic resonance imaging.

Traumatic brain injury (TBI) is caused by a sudden external force and can be very heterogeneous in its manifestation. In this work, we analyse T1-weighted magnetic resonance (MR) brain images that were prospectively acquired from patients who sustained mild to severe TBI. We investigate the potential of a recently proposed automatic segmentation method to support the outcome prediction of TBI. Specifically, we extract meaningful cross-sectional and longitudinal measurements from acute- and chronic-phase MR images. We calculate regional volume and asymmetry features at the acute/subacute stage of the injury (median: 19 days after injury), to predict the disability outcome of 67 patients at the chronic disease stage (median: 229 days after injury). Our results indicate that small structural volumes in the acute stage (e.g. of the hippocampus, accumbens, amygdala) can be strong predictors for unfavourable disease outcome. Further, group differences in atrophy are investigated. We find that patients with unfavourable outcome show increased atrophy. Among patients with severe disability outcome we observed a significantly higher mean reduction of cerebral white matter (3.1%) as compared to patients with low disability outcome (0.7%).

Impact of Intracranial Pressure and Cerebral Perfusion Pressure on Severe Disability and Mortality After Head Injury

To investigate the relationships between intracranial pressure (ICP), cerebral perfusion pressure (CPP), and outcome after traumatic brain injury. A retrospective analysis of prospectively recorded data from 429 patients after head injury requiring intensive treatment on the Neuroscience Intensive Annex and the Neuro Critical Care Unit, Cambridge, UK. ICP, CPP, and arterial blood pressure (ABP) were continuously recorded. Mean values of pressures were compared to outcome assessed at 6 months after injury (using the Glasgow Outcome Scale). The mortality rate was greater in those having mean ICP greater than 20 mmHg (17% below versus 47% above; p < 0.0001). The mortality rate was dramatically increased for CPP below 55 mmHg (81% below versus 23% above; p < 0.0001). For values of CPP greater than 95 mmHg, favorable outcome was less frequent (50% below versus 28% above; p < 0.033). The rate of severe disability showed the tendency to increase with CPP ( r = 0.87; p = 0.02), suggesting that a higher CPP does not help in achieving favorable outcomes. ICP was greater in those who died in comparison to those who survived (27 +/- 19 mmHg versus 16 +/- 6 mmHg; p < 0.10 - 7), and CPP was lower (68 +/- 21 versus 76 +/- 10 mmHg; p < 0.0002). There was no difference between mean ICP and CPP in good/moderate and severe disability outcome groups. High ICP is strongly associated with fatal outcome. Excessive CPP seems to reduce the probability of achieving a favorable outcome following head trauma.