Dataset Information

Comparing Predictive Utility of Head Computed Tomography Scan-Based Scoring Systems for Traumatic Brain Injury: A Retrospective Study.

ABSTRACT: This study compared the predictive utility of Marshall, Rotterdam, Stockholm, Helsinki, and NeuroImaging Radiological Interpretation System (NIRIS) scorings based on early non-contrast brain computed tomography (CT) scans in patients with traumatic brain injury (TBI). The area under a receiver operating characteristic curve (AUROC) was used to determine the predictive utility of scoring systems. Subgroup analyses were performed among patients with head AIS scores > 1. A total of 996 patients were included, of whom 786 (78.9%) were males. In-hospital mortality, ICU admission, neurosurgical intervention, and prolonged total hospital length of stay (THLOS) were recorded for 27 (2.7%), 207 (20.8%), 82 (8.2%), and 205 (20.6%) patients, respectively. For predicting in-hospital mortality, all scoring systems had AUROC point estimates above 0.9 and 0.75 among all included patients and patients with head AIS > 1, respectively, without any significant differences. The Marshall and NIRIS scoring systems had higher AUROCs for predicting ICU admission and neurosurgery than the other scoring systems. For predicting THLOS ≥ seven days, although the NIRIS and Marshall scoring systems seemed to have higher AUROC point estimates when all patients were analyzed, five scoring systems performed roughly the same in the head AIS > 1 subgroup.

SUBMITTER: Khormali M

PROVIDER: S-EPMC10452909 | biostudies-literature | 2023 Jul

REPOSITORIES: biostudies-literature

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Comparing Predictive Utility of Head Computed Tomography Scan-Based Scoring Systems for Traumatic Brain Injury: A Retrospective Study.

Khormali Moein M Soleimanipour Saeed S Baigi Vali V Ehteram Hassan H Talari Hamidreza H Naghdi Khatereh K Ghaemi Omid O Sharif-Alhoseini Mahdi M

Brain sciences 20230729 8

This study compared the predictive utility of Marshall, Rotterdam, Stockholm, Helsinki, and NeuroImaging Radiological Interpretation System (NIRIS) scorings based on early non-contrast brain computed tomography (CT) scans in patients with traumatic brain injury (TBI). The area under a receiver operating characteristic curve (AUROC) was used to determine the predictive utility of scoring systems. Subgroup analyses were performed among patients with head AIS scores > 1. A total of 996 patients wer ...[more]

PMID: 37626500

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Project description:ObjectivesComputed tomography angiography (CTA) is the imaging modality most frequently used to diagnosis type A aortic dissection for chest pain with a high degree of sensitivity and specificity. False negative and positive errors in diagnosis are infrequent. Despite initial negative imaging studies for dissection, surgeons must consider early operation in patients with recent onset chest pain in the presence of an ascending aortic aneurysm.MethodsWe report 4 cases (2004-2021) of patients with a mean age of 51.25 years (male:female = 3:1) who presented with chest pain. Two had a history of syncope. On computed tomography angiography, all had an ascending aortic aneurysm and no dissection flap. Three had thickening of the ascending aorta and 1 had a chronic type B dissection. On echocardiography, aortic regurgitation was moderate-severe in 2 patients, 2 had a pericardial effusion, and none had a definitive dissection flap. All were operated on because of the surgeon's concern for the association of chest pain and an ascending aortic aneurysm. The Institutional Review Board at George Washington University Committee on Human Research has determined that the research is exempt from review under Department of Health and Human Services regulatory category 4 (#FWA00005945). The project as described in the application may proceed without further oversight by the Office of Human Resources on September 9, 2022.ResultsThe diagnosis of type A aortic dissection was made at operation (3 on median sternotomy and 1 after aortotomy). All patients did well. One patient who had peripheral cannulation (no malperfusion) and severe coagulopathy developed a compartment syndrome and postoperatively required a below-knee amputation.ConclusionsSurgeons must maintain a high index of suspicion for aortic dissection when patients present with chest pain and are found to have an ascending aortic aneurysm even in the absence of initial, classic features of dissection on computed tomography angiography. Improvements in imaging techniques and analysis are required.

Project description:BackgroundTraumatic brain injury (TBI) is a major contributor to morbidity and mortality. Computerized tomography (CT) scanning of the brain is essential for diagnostic screening of intracranial injuries in need of neurosurgical intervention, but may also provide information concerning patient prognosis and enable baseline risk stratification in clinical trials. Novel CT scoring systems have been developed to improve current prognostic models, including the Stockholm and Helsinki CT scores, but so far have not been extensively validated. The primary aim of this study was to evaluate the Stockholm and Helsinki CT scores for predicting functional outcome, in comparison with the Rotterdam CT score and Marshall CT classification. The secondary aims were to assess which individual components of the CT scores best predict outcome and what additional prognostic value the CT scoring systems contribute to a clinical prognostic model.Methods and findingsTBI patients requiring neuro-intensive care and not included in the initial creation of the Stockholm and Helsinki CT scoring systems were retrospectively included from prospectively collected data at the Karolinska University Hospital (n = 720 from 1 January 2005 to 31 December 2014) and Helsinki University Hospital (n = 395 from 1 January 2013 to 31 December 2014), totaling 1,115 patients. The Marshall CT classification and the Rotterdam, Stockholm, and Helsinki CT scores were assessed using the admission CT scans. Known outcome predictors at admission were acquired (age, pupil responsiveness, admission Glasgow Coma Scale, glucose level, and hemoglobin level) and used in univariate, and multivariable, regression models to predict long-term functional outcome (dichotomizations of the Glasgow Outcome Scale [GOS]). In total, 478 patients (43%) had an unfavorable outcome (GOS 1-3). In the combined cohort, overall prognostic performance was more accurate for the Stockholm CT score (Nagelkerke's pseudo-R2 range 0.24-0.28) and the Helsinki CT score (0.18-0.22) than for the Rotterdam CT score (0.13-0.15) and Marshall CT classification (0.03-0.05). Moreover, the Stockholm and Helsinki CT scores added the most independent prognostic value in the presence of other known clinical outcome predictors in TBI (6% and 4%, respectively). The aggregate traumatic subarachnoid hemorrhage (tSAH) component of the Stockholm CT score was the strongest predictor of unfavorable outcome. The main limitations were the retrospective nature of the study, missing patient information, and the varying follow-up time between the centers.ConclusionsThe Stockholm and Helsinki CT scores provide more information on the damage sustained, and give a more accurate outcome prediction, than earlier classification systems. The strong independent predictive value of tSAH may reflect an underrated component of TBI pathophysiology. A change to these newer CT scoring systems may be warranted.

Dataset Information

Comparing Predictive Utility of Head Computed Tomography Scan-Based Scoring Systems for Traumatic Brain Injury: A Retrospective Study.

Publications

Comparing Predictive Utility of Head Computed Tomography Scan-Based Scoring Systems for Traumatic Brain Injury: A Retrospective Study.

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