The TRACK-TBI investigators are listed in the Appendix on page xxx.
Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury
Article first published online: 7 DEC 2012
Copyright © 2012 American Neurological Association
Annals of Neurology
Volume 73, Issue 2, pages 224–235, February 2013
How to Cite
Yuh, E. L., Mukherjee, P., Lingsma, H. F., Yue, J. K., Ferguson, A. R., Gordon, W. A., Valadka, A. B., Schnyer, D. M., Okonkwo, D. O., Maas, A. I. R., Manley, G. T. and the TRACK-TBI Investigators (2013), Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury. Ann Neurol., 73: 224–235. doi: 10.1002/ana.23783
- Issue published online: 22 MAR 2013
- Article first published online: 7 DEC 2012
- Accepted manuscript online: 11 OCT 2012 01:49AM EST
- Manuscript Accepted: 28 SEP 2012
- Manuscript Revised: 25 SEP 2012
- Manuscript Received: 11 JUL 2012
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).
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.
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.
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. ANN NEUROL 2013;73:224–235