Day-of-injury computerized tomography, rehabilitation status, and development of cerebral atrophy in persons with traumatic brain injury.
OBJECTIVE
To compare day-of-injury (DOI) computerized tomography (CT) findings with acute injury severity markers, disability at acute hospital admission and discharge from inpatient rehabilitation, injury severity markers, and degree of postacute cerebral atrophy on magnetic resonance imaging (MRI).


METHODS
Retrospective chart review of 240 consecutive traumatic brain injury (TBI) admissions (mean age 31.7 +/- 15.8 yrs) with moderate-to-severe initial brain injury. All DOI CT abnormalities were qualitatively rated. Disability was assessed using the Disability Rating Scale (DRS) and the FIM measure. In a representative subset, cerebral atrophy was determined by the ventricle-to-brain ratio (VBR) method and quantified from MRI scans 25 or more days postinjury.


RESULTS
CT classification resulted in nonsignificant differences in DRS and FIM ratings at the time of discharge from the rehabilitation unit, except in brainstem injury subjects who had significantly higher DRS and lower FIM scores at rehabilitation discharge. At 25 or more days postinjury, presence of any DOI CT abnormality was associated with larger VBR. Increased VBR, as an index of cerebral atrophy, was associated with worse rehabilitation discharge DRS and FIM ratings.


CONCLUSIONS
Other than brainstem injury, DOI CT findings relate poorly to rehabilitation outcome. Presence of DOI CT abnormalities were associated with the development of cerebral atrophy, which was associated with poorer rehabilitation discharge DRS and FIM scores.
Bigler
Erin D
ED
Department of Psychology, Brigham Young University, Provo, Utah 84602, USA.
Ryser
David K
DK
Gandhi
Partha
P
Kimball
Jordan
J
Wilde
Elisabeth A
EA
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000209:etiology*; D001921:Brain / Q000473:pathology*; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D020127:Recovery of Function; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D012307:Risk Factors; D013995:Time; D013997:Time Factors; D014055:Tomography, Emission-Computed