title: Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Brain and Spinal Injury Center, San Francisco, CA, USA.
authors.forename: Esther L
authors.initials: EL
authors.lastname: Yuh
authors.forename: Pratik
authors.initials: P
authors.lastname: Mukherjee
authors.forename: Hester F
authors.initials: HF
authors.lastname: Lingsma
authors.forename: John K
authors.initials: JK
authors.lastname: Yue
authors.forename: Adam R
authors.initials: AR
authors.lastname: Ferguson
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Gordon
authors.forename: Alex B
authors.initials: AB
authors.lastname: Valadka
authors.forename: David M
authors.initials: DM
authors.lastname: Schnyer
authors.forename: David O
authors.initials: DO
authors.lastname: Okonkwo
authors.forename: Andrew I R
authors.initials: AI
authors.lastname: Maas
authors.forename: Geoffrey T
authors.initials: GT
authors.lastname: Manley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000592:standards* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000592:standards* / Q000706:statistics & numerical data; D014193:Trauma Centers; D015599:Trauma Severity Indices; D055815:Young Adult