Patients with brain contusions: predictors of outcome and relationship between radiological and clinical evolution

Clinical article

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  • 1 Arcispedale Santa Maria Nuova–Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia; and Neurosurgery-Neurotraumatology Unit,
  • | 2 Intensive Care Unit,
  • | 3 Department of Biostatistics, and
  • | 4 Department of Neuroradiology, University Hospital of Parma, Parma, Italy
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Object

Traumatic parenchymal mass lesions are common sequelae of traumatic brain injuries (TBIs). They occur in up to 8.2% of all TBI cases and 13%–35% of severe TBI cases, and they account for up to 20% of surgical intracranial lesions. Controversy exists concerning the association between radiological and clinical evolution of brain contusions. The aim of this study was to identify predictors of unfavorable outcome, analyze the evolution of brain contusions, and evaluate specific indications for surgery.

Methods

In a retrospective, multicenter study, patients with brain contusions were identified in separate patient cohorts from 11 hospitals over a 4-year period (2008–2011). Data on clinical parameters and course of the contusion were collected. Radiological parameters were registered by using CT images taken at the time of hospital admission and at subsequent follow-up times. Patients who underwent surgical procedures were identified. Outcomes were evaluated 6 months after trauma by using the Glasgow Outcome Scale-Extended.

Results

Multivariate analysis revealed the following reliable predictors of unfavorable outcome: 1) increased patient age, 2) lower Glasgow Coma Scale score at first evaluation, 3) clinical deterioration in the first hours after trauma, and 4) onset or increase of midline shift on follow-up CT images. Further multivariate analysis identified the following as statistically significant predictors of clinical deterioration during the first hours after trauma: 1) onset of or increase in midline shift on follow-up CT images (p < 0.001) and 2) increased effacement of basal cisterns on follow-up CT images (p < 0.001).

Conclusions

In TBI patients with cerebral contusion, the onset of clinical deterioration is predictably associated with the onset or increase of midline shift and worsened status of basal cisterns but not with hematoma or edema volume increase. A combination of clinical deterioration and increased midline shift/basal cistern compression is the most reasonable indicator for surgery.

Abbreviations used in this paper:

GCS = Glasgow Coma Scale; GOSE = Glasgow Outcome Scale-Extended; ICP = intracranial pressure; IQR = interquartile range; ROC = receiver operating characteristic; TBI = traumatic brain injury.

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Contributor Notes

Address correspondence to: Franco Servadei, M.D., Department of Emergency Medicine, Neurosurgery-Neurotraumatology Unit, University Hospital of Parma and ASMN-IRCCS Reggio Emilia, Viale Gramsci 14, Parma 43100, Italy. email: fservadei@ao.pr.it.

Please include this information when citing this paper: published online February 7, 2014; DOI: 10.3171/2013.12.JNS131090.

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