Isolated Traumatic Subarachnoid Hemorrhage on Head Computed Tomography Scan May Not Be Isolated: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (TRACK-TBI) Study.

Autor: Yue JK; Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA., Yuh EL; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.; Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA., Elguindy MM; Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA., Sun X; Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA., van Essen TA; Department of Neurological Surgery, Leiden University Medical Center, Leiden, the Netherlands., Deng H; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Belton PJ; Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA., Satris GG; Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA., Wong JC; Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA., Valadka AB; Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA., Korley FK; Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA., Robertson CS; Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA., McCrea MA; Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Stein MB; Department of Psychiatry, University of California, San Diego, La Jolla, California, USA., Diaz-Arrastia R; Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Wang KKW; Center for Neurotrauma, Multiomics and Biomarkers, Morehouse School of Medicine, Atlanta, Georgia, USA., Temkin NR; Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle, Washington, USA., DiGiorgio AM; Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.; Institute of Health Policy Studies, University of California, San Francisco, San Francisco, California, USA., Tarapore PE; Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA., Huang MC; Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA., Markowitz AJ; Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA., Puccio AM; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Mukherjee P; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.; Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA., Okonkwo DO; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Jain S; Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA., Manley GT; Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
Jazyk: angličtina
Zdroj: Journal of neurotrauma [J Neurotrauma] 2024 Jun; Vol. 41 (11-12), pp. 1310-1322. Date of Electronic Publication: 2024 Apr 11.
DOI: 10.1089/neu.2023.0253
Abstrakt: Isolated traumatic subarachnoid hemorrhage (tSAH) after traumatic brain injury (TBI) on head computed tomography (CT) scan is often regarded as a "mild" injury, with reduced need for additional workup. However, tSAH is also a predictor of incomplete recovery and unfavorable outcome. This study aimed to evaluate the characteristics of CT-occult intracranial injuries on brain magnetic resonance imaging (MRI) scan in TBI patients with emergency department (ED) arrival Glasgow Coma Scale (GCS) score 13-15 and isolated tSAH on CT. The prospective, 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (TRACK-TBI; enrollment years 2014-2019) enrolled participants who presented to the ED and received a clinically-indicated head CT within 24 h of TBI. A subset of TRACK-TBI participants underwent venipuncture within 24 h for plasma glial fibrillary acidic protein (GFAP) analysis, and research MRI at 2-weeks post-injury. In the current study, TRACK-TBI participants age ≥17 years with ED arrival GCS 13-15, isolated tSAH on initial head CT, plasma GFAP level, and 2-week MRI data were analyzed. In 57 participants, median age was 46.0 years [quartile 1 to 3 (Q1-Q3): 34-57] and 52.6% were male. At ED disposition, 12.3% were discharged home, 61.4% were admitted to hospital ward, and 26.3% to intensive care unit. MRI identified CT-occult traumatic intracranial lesions in 45.6% (26 of 57 participants; one additional lesion type: 31.6%; 2 additional lesion types: 14.0%); of these 26 participants with CT-occult intracranial lesions, 65.4% had axonal injury, 42.3% had subdural hematoma, and 23.1% had intracerebral contusion. GFAP levels were higher in participants with CT-occult MRI lesions compared with without (median: 630.6 pg/mL, Q1-Q3: [172.4-941.2] vs. 226.4 [105.8-436.1], p  = 0.049), and were associated with axonal injury (no: median 226.7 pg/mL [109.6-435.1], yes: 828.6 pg/mL [204.0-1194.3], p  = 0.009). Our results indicate that isolated tSAH on head CT is often not the sole intracranial traumatic injury in GCS 13-15 TBI. Forty-six percent of patients in our cohort (26 of 57 participants) had additional CT-occult traumatic lesions on MRI. Plasma GFAP may be an important biomarker for the identification of additional CT-occult injuries, including axonal injury. These findings should be interpreted cautiously given our small sample size and await validation from larger studies.
Databáze: MEDLINE