Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury.
Day-of-injury (DOI) brain lesion volumes in traumatic brain injury (TBI) patients are rarely used to predict long-term outcomes in the acute setting. The purpose of this study was to investigate the relationship between acute brain injury lesion volume and rehabilitation outcomes in patients with TBI at a level one trauma center.



Patients with TBI who were admitted to our rehabilitation unit after the acute care trauma service from February 2009-July 2011 were eligible for the study. Demographic data and outcome variables including cognitive and motor Functional Independence Measure (FIM) scores, length of stay (LOS) in the rehabilitation unit, and ability to return to home were obtained. The DOI quantitative injury lesion volumes and degree of midline shift were obtained from DOI brain computed tomography scans. A multiple stepwise regression model including 13 independent variables was created. This model was used to predict postrehabilitation outcomes, including FIM scores and ability to return to home. A p value less than 0.05 was considered significant.



Ninety-six patients were enrolled in the study. Mean age was 43 ± 21 years, admission Glasgow Coma Score was 8.4 ± 4.8, Injury Severity Score was 24.7 ± 9.9, and head Abbreviated Injury Scale score was 3.73 ± 0.97. Acute hospital LOS was 12.3 ± 8.9 days, and rehabilitation LOS was 15.9 ± 9.3 days. Day-of-injury TBI lesion volumes were inversely associated with cognitive FIM scores at rehabilitation admission (p = 0.004) and discharge (p = 0.004) and inversely associated with ability to be discharged to home after rehabilitation (p = 0.006).



In a cohort of patients with moderate to severe TBI requiring a rehabilitation unit stay after the acute care hospital stay, DOI brain injury lesion volumes are associated with worse cognitive FIM scores at the time of rehabilitation admission and discharge. Smaller-injury volumes were associated with eventual discharge to home. Volumetric neuroimaging in the acute injury phase may improve surgeons' ultimate outcome predictions in TBI patients.



Prognostic/epidemiologic study, level V.
From the Division of Trauma Services and Surgical Critical Care (S.M., M.S.), Intermountain Medical Center, Murray, UT; Department of Emergency Medicine (J.B.), Intermountain Medical Center, Murray, UT; Department of Rehabilitation Medicine (D.R.), Intermountain Medical Center, Murray, UT; Department of Medicine, Pulmonary and Critical Care Division (R.H.), Intermountain Medical Center, Murray, Utah; Center for Humanizing Critical Care, Intermountain Medicine, Murray, Utah and Department of Psychology and Neuroscience Center (R.H.), Brigham Young University, Provo, UT; Department of Psychology (J.F.), Brigham Young University, Provo, UT; Department of Psychiatry (R.B.F), University of New Mexico College of Medicine, Albuquerque, NM; Department of Psychology (R.B.F), Brigham Young University, Provo, UT; Department of Neurosurgery (J.M.), University of Utah, Salt Lake City, UT; Intermountain Medical Center, Murray, UT; Institute for Clinical Outcomes Research (R.B., S.H.), Salt Lake City, UT; Department of Radiology (D.P.), Intermountain Medical Center; Department of Psychology and Neuroscience Center (E.B.), Brigham Young University, Provo, UT; Division of Trauma Services (S.G), Intermountain Medical Center, Murray, UT; and Department of Psychology and Neuroscience Center (M.L.), Brigham Young University, Provo, UT.
Sarah
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Majercik
Joseph
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Bledsoe
David
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Ryser
Ramona O
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Hopkins
Joseph E
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Fair
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Brock Frost
Joel
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MacDonald
Ryan
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Barrett
Susan
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Horn
David
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Pisani
Erin D
ED
Bigler
Scott
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Gardner
Mark
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Stevens
Michael J
MJ
Larson
D015998:Abbreviated Injury Scale; D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging* / Q000534:rehabilitation*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011379:Prognosis; D020127:Recovery of Function; D012047:Rehabilitation Centers; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014589:Utah