Influence of frontal abnormalities on admission CT on long-term functional outcome of patients with traumatic brain injury.

Voorthuizen, E.L. van (2014) Influence of frontal abnormalities on admission CT on long-term functional outcome of patients with traumatic brain injury. thesis, Medicine.

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Abstract

Background: Patients with traumatic brain injury (TBI) commonly experience residual disabilities, interfering with return to work (RTW). Beside cognitive and social impairments, behavioral problems are frequently encountered. As the frontal areas of the brain are associated with behavior, abnormalities seen on computed tomography (CT) could be related to behavioral outcome. Objective: The aim of the study was to predict the development of behavioral problems based on frontal contusions determined with admission CT in TBI patients with various severities. Additionally, the relation between frontal abnormalities and outcome defined by the GOSE (Glasgow Outcome Scale Extended) and RTW will be investigated. Methods: Retrospective analysis was performed on a prospective observational cohort of adult TBI patients admitted to the University Medical Centre Groningen (UMCG) between 1996 and 2012. Categories of mild, moderate, and severe TBI were based on the Glasgow Coma Score (GCS). Inclusion criteria were data of CT imaging in the acute phase and outcome data available at 6 months (mild TBI) or 12 months (moderate and severe TBI) on the Glasgow Outcome Scale Extended (GOSE) and the Differentiated Outcome Score (DOS). Patients with death or vegetative state as outcome were excluded. CT scans were classified using the Marshall CT classification and Rotterdam CT score. Patients with frontal contusions and extended frontal contusions were compared to patients without frontal contusions. Multivariate logistic regression was applied for outcome on the behavioral domain of the DOS, the GOSE, and RTW to determine predictors and relevance of frontal contusions. Results: In total 219 mild, 100 moderate and 221 severe TBI patients were included in the study, with mean age of 37 years. 75% of the patients were male. CT was abnormal in 72% of patients including 85 patients with uni- or bilateral frontal contusions and 61 with extended frontal contusions. Agreement between raters on scores of Marshall CT classification was good (Cohen’s kappa= and 0.76 – 0.84). Behavioral problems were found in 46% of patients, 13% had unfavorable outcome on the GOSE, and 51% did not completely resume work. Patients experiencing impairments showed more frequently frontal contusions on CT. Predictors for behavioral problems were lower GCS, presence of cerebral edema, intraventricular hemorrhage, and frontal contusions (Nagelkerke R2= 0.41). Combined, these predictors showed a higher predictive value than Marshall CT classification or the Rotterdam CT score. Age did not influence outcome on the behavioral domain. Presence of frontal contusions was predictive of unfavorable outcome on the GOSE and incomplete return to work, in addition to known predictors. In the subgroup of mild TBI patients, the predictive models were not applicable. Conclusion: The presence of frontal contusions increases the risk of behavioral problems, and is an important factor in predicting outcome on this domain. Injury severity, presence of intraventricular hemorrhage and cerebral edema also increased the likelihood of behavioral problems. Early prediction of behavioral problems could facilitate targeted rehabilitation in the first year after injury.

Item Type:	Thesis (Thesis)
Supervisor name:	Naalt, Dr. J. van der
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:50
Last Modified:	25 Jun 2020 10:50
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1079

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