| Autor: |
Fletcher-Sandersjöö A; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.; Department of Clinical Neuroscience, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden., Svedung Wettervik T; Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden., Tatter C; Department of Clinical Neuroscience, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden.; Department of Radiology, Stockholm Southern Hospital, Stockholm, Sweden., Tjerkaski J; Department of Clinical Neuroscience, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden., Nelson DW; Function Perioperative Care and Medicine, Karolinska University Hospital, Stockholm, Sweden.; Department of Physiology and Pharmacology, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden., Maegele M; Department for Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center, University Witten/Herdecke, Cologne, Germany.; Institute for Research in Operative Medicine, University Witten/Herdecke, Cologne, Germany., Svensson M; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.; Department of Clinical Neuroscience, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden., Lewén A; Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden., Enblad P; Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden., Bellander BM; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.; Department of Clinical Neuroscience, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden., Thelin EP; Department of Clinical Neuroscience, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden.; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden. |
| Abstrakt: |
Contusion expansion (CE) is a potentially treatable outcome predictor in traumatic brain injury (TBI), and a suitable end-point for hemostatic therapy trials. However, there is no consensus on the definition of clinically relevant CE, both in terms of measurement criteria (absolute vs. relative volume increase) and cutoff values. In light of this, the aim of this study was to assess the predictive abilities of different CE definitions on outcome. We performed a multi-center observational cohort study of adults with moderate-to-severe TBI treated in an intensive care unit. The exposure of interest was CE, defined as the absolute and relative volume change between the first and second computed tomography scan. The primary outcome was the Glasgow Outcome Scale (GOS) at 6-12 months post-injury, dichotomized into unfavorable (GOS ≤3) or favorable (GOS ≥4). The secondary outcome was all-cause mortality. In total, 798 patients were included, with a median duration of 7.0 h between the first and second CT scan. The median absolute and relative CE was 1.5 mL (interquartile range [IQR] 0.1-8.3 mL) and 100% (IQR 10-530%), respectively. Both CE forms were independently associated with unfavorable GOS. Absolute CE outperformed relative CE in predicting both unfavorable GOS (area under the curve [AUC]: 0.65 vs. 0.60, p = 0.002) and all-cause mortality (AUC: 0.66 vs. 0.60, p = 0.003). For dichotomized CE, absolute cutoffs of 1-10 mL yielded the best results. We conclude that absolute CE demonstrates stronger outcome correlation than relative CE. In studies focusing on lesion progression in TBI, it may be advantageous to use absolute CE as the primary outcome metric. For dichotomized outcomes, cutoffs between 1 and 10 mL are suggested, depending on the desired sensitivity-specificity balance. |
