http://orcid.org/0000-0001-9694-7722
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ABSTRACT
Introduction: Mild traumatic brain injury (MTBI) can cause persistent functional deficits and healthcare burden. Understanding the association between intracranial contusions and outcome may aid in MTBI treatment and prognosis.
Methods: MTBI patients with Glasgow Coma Scale 13–15 and 6-month outcomes [Glasgow Outcome Scale-Extended (GOSE)], without polytrauma from the prospective TRACK-TBI Pilot study were analyzed. Intracranial contusions on computed tomography (CT) were coded by location. Multivariable regression evaluated associations between intracranial injury type (temporal contusion [TC], frontal contusion, extraaxial [epidural/subdural/subarachnoid], other-intraaxial [intracerebral/intraventricular hemorrhage, axonal injury]) and GOSE. Odds ratios (OR) are reported.
Results: Overall, 260 MTBI subjects were aged 44.4 ± 18.1-years; 67.7% were male. Ninety-seven subjects were CT-positive and 46 had contusions (41.3%–frontal, 30.4%–temporal, 21.7%–frontal + temporal, 2.2% each-parietal/occipital/brainstem); 95.7% had concurrent extraaxial hemorrhage. Mortality was 0% at discharge and 2.3% by 6-months.
GOSE distribution was 2.3%–death, 1.5%–severe disability, 27.7%–moderate disability, 68.5%–good recovery. Forty-six percent of TC-positive subjects suffered moderate disability or worse (GOSE ≤6) and 41.7% were unable to return to baseline work capacity (RTBWC), compared to 29.1%/20.4% for CT-negative and 26.1%/20.9% for CT-positive subjects without TC. On multivariable regression, TC associated with OR = 3.33 (95% CI [1.16–9.60], p = 0.026) for GOSE ≤6, and OR = 4.48 ([1.49–13.51], p = 0.008) for inability to RTBWC.
Conclusions: Parenchymal contusions in MTBI are often accompanied by extraaxial hemorrhage. TCs may be associated with 6-month functional impairment. Their presence on imaging should alert the clinician to the need for heightened surveillance of sequelae complicating RTBWC, with low threshold for referral to services.
Acknowledgments
Amy J. Markowitz, JD, provided editorial support. The authors would like to thank the following contributors to the development of the TRACK-TBI database and repositories by organization and in alphabetical order by last name: One Mind for Research: General Peter Chiarelli, U.S. Army (Ret.), Garen Staglin, MBA; QuesGen Systems, Inc.: Vibeke Brinck, MS, Michael Jarrett, MBA; Thomson Reuters: Sirimon O’Charoen, PhD.
Disclosure statement
No potential conflict of interest was reported by the authors.
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Notes on contributors
John K. Yue
Dr. John K. Yue, MD is a Neurosurgery Resident at University of California San Francisco (UCSF; San Francisco, CA, USA). He received his MD from UCSF School of Medicine. He has authored over 80 peer-reviewed publications in neurosurgery and neurotrauma with special focus on traumatic brain injury, spine and spinal cord injury, biomarkers, genetics, and outcomes.
Ethan A. Winkler
Dr. Ethan A. Winkler, MD, PhD is a Neurosurgery Chief Resident at UCSF. He received his MD and PhD from University of Rochester School of Medicine (Rochester, NY, USA). He is the author of over 70 peer-reviewed publications in neurovascular disorders, neurosurgical approaches, and neurotrauma. He is an expert on the role of pericytes in central nervous system disorders.
Ross C. Puffer
Dr. Ross C. Puffer, MD is a Neurosurgery Chief Resident at Mayo Clinic (Rochester, MN, USA). He received his MD from Mayo Clinic School of Medicine. He is the author of over 40 peer-reviewed publications in neurosurgery, with focus on operative techniques in spine and peripheral nerve injury.
Hansen Deng
Mr. Hansen Deng, BA is a Medical Student at UCSF with 20 peer-reviewed publications and several oral presentations in operative neurosurgery, neurotrauma and spine/spinal cord injury.
Ryan R. L. Phelps
Mr. Ryan R. L. Phelps, BA is a Medical Student at UCSF, and a current research fellow at the National Institutes of Health (NIH), with focus in neurosurgery.
Sagar Wagle
Dr. Sagar Wagle, MD is a Diagnostic Radiology Resident at Mayo Clinic (Rochester, MN). He received his MD from UCSF School of Medicine. He has authored several publications in pediatric skeletal deformities and sacroiliac joint disorders.
Molly Rose Morrissey
Ms. Molly Rose Morrissey, BS is a Master’s of Science in Nursing student at UCSF School of Nursing. She has authored several publications in neurotrauma, presented at national conferences, and has a special interest in rehabilitation and improving geriatic outcomes after trauma.
Ernesto J. Rivera
Mr. Ernesto J. Rivera, BA is a Neurosurgery Research Coordinator at UCSF, with interests in community medicine and global health, improving patient health access, and reducing health disparities.
Sarah J. Runyon
Ms. Sarah J. Runyon, BA is a Neurosurgery Research Coordinator at UCSF, with interests in cognitive psychology, functional rehabilitation, and improving patient outcomes after trauma.
Mary J. Vassar
Ms. Mary J. Vassar, RN, MS is the Executive Director in the Department of Neurosurgery at UCSF. Her background includes research officerships in prevention, quality and costs for large academic centers and multicenter clinical trials, as well as regulatory experience in federal and local goverments. She has authored over 30 peer-reviewed publications in healthcare policy and epidemiology.
Sabrina R. Taylor
Dr. Sabrina R. Taylor, PhD is the Director of Clinical Studies in the Department of Neurosurgery at UCSF. She received her PhD in Neuroscience at Dartmouth College (Hanover, NH, USA). She has presented numerous talks at national conferences and has high-level experience in neuroscience and traumatic brain injury clinical research and team management.
Maryse C. Cnossen
Dr. Maryse C. Cnossen, PhD is an Epidemiologist and Postdoctoral Scholar at Erasmus Medical Center (Rotterdam, The Netherlands). She received her PhD in Epidemiology from Erasmus University Rotterdam and the Netherlands Institute for Health Sciences. She is the author of over 30 peer-reviewed publications and living systematic reviews, with a special focus on global epidemiology of traumatic brain injury, and advanced statistical modeling and outcomes prediction in large multicenter trials.
Hester F. Lingsma
Dr. Hester F. Lingsma, PhD is an Epidemiologist and Associate Professor of Medical Decision Making at Erasmus Medical Center. She received her PhD in Public Health from Erasmus University Rotterdam. She is a lead investigator in numerous large multicenter clinical trials for trauma, traumatic brain injury, stroke, and healthcare quality. She has authored over 200 peer-reviewed publications.
Esther L. Yuh
Dr. Esther L. Yuh, MD, PhD is an Associate Professor of Radiology and Attending Neuroradiologist at UCSF. She received her MD and PhD from Stanford University (Stanford, CA, USA), and completed residency and fellowship in Neuroradiology at UCSF. She is an expert in diagnostic neuroradiology, traumatic brain injury, stroke and neurodegenerative disorders, and a lead investigator of numerous large multicenter trials for neurological disorders. She has authored over 40 peer-reviewed publications.
Pratik Mukherjee
Dr. Pratik Mukherjee, MD, PhD is a Professor of Radiology and Attending Radiologist at UCSF, Director of the Neural Connectivity Lab at UCSF, and Director of the Center for Imaging of Neurodegenerative Diseases (CIND) at the San Francisco Veterans Affairs Medical Center (San Francisco, CA, USA). He received his MD from Cornell University (Ithaca, NY, USA), PhD in Neuroscience at Rockefeller University (New York City, NY, USA) and completed residency and fellowship in Neuroradiology at Washington University Medical Center in St. Louis (St. Louis, MO, USA). His primary research focuses on neurodevelopmental disorders and traumatic brain injury, technical development, neuroscience and clinical applications of advanced imaging methods. He has served as the principal investigator or co-principal investigator of numerous NIH, U.S. Department of Defense, and public foundation grants. He has authored over 140 peer-reviewed publications.
David M. Schnyer
Dr. David M. Schnyer, PhD is a Associate Professor of Psychology and Neuroscience at University of Texas at Austin (Austin, TX, USA). He received his PhD in Clinical Psychology and Neuropsychology from University of Arizona (Tucson, AZ, USA). His research is focused on cognitive neuroscience of memory and decision-making, associative memory, and metamemory using advanced neuroimaging. He is a lead or co-lead investigator of multiple NIH grants and has authored over 80 peer-reviewed publications.
Ava M. Puccio
Dr. Ava M. Puccio, RN, PhD is an Assistant Professor of Neurosurgery and Co-Director of the Neurotrauma Clinical Trials Center at University of Pittsburgh Medical Center (Pittsburgh, PA, USA). She receivdd her PhD in Nursing and Neuroscience from the University of Pittsburgh. Her specialized interests include secondary injury mechanisms following traumatic brain injury, controlled normothermia and hypothermia, benetic expression, and pharmacotherapy. She is a lead or co-lead investigator of multiple NIH grants and has authored over 80 peer-reviewed publications.
Alex B. Valadka
Dr. Alex B. Valadka, MD is Professor and Chair of Neurosurgery at Virginia Commonwealth University (Richmond, VA, USA). He received his MD from University of Chicago Prizker School of Medicine (Chicago, IL, USA) and completed residency in Neurosurgery at the Medical College of Virginia. He has served as Chair of the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Section on Neurotrauma and Critical Care, Chair of the Neurosurgical Specialty Group of the American College of Surgeons on Trauma, Chair of the AANS Public Relations and Membership Committees, and Chair of the Washington Committee for Neurosurgery. He is the President-Elect of the AANS and a Director of the American Board of Neurological Surgeons. He helped establish the Seton Brain and Spine Institute and served as Chair and Chief Executive Officer. His research interests include cerebral blood flow and metabolism after traumatic brain injury, biochemical markers of brain injury, and organized efforts with medical and governmental organizations to improve the delivery of emergency neurosurgical care. He has authored over 100 peer-reviewed publications.
David O. Okonkwo
Dr. David O. Okonkwo, MD, PhD is Professor and Executive Vice Chair of Neurosurgery and Director of the Neurotrauma Clinical Trials Center at University of Pittsburgh Medical Center. He received his MD and PhD from the Medical College of Virginia. He completed residency in Neurosurgery at University of Virginia and fellowship at Auckland Public Hospital (Auckland, New Zealand). His clinical interest are traumatic brain and spine injury, spinal deformity and scoliosis. His research endeavors include developing advanced neuroimaging modalities and novel therapeutic interventions for brain and spinal cord injury. He is lead and co-lead investigator of numerous federal and foundation grants, multicenter clinical trials, including the nationally-funded clinical core to study pathophysiology of traumatic brain injury. He has authored over 200 peer-reviewed publications.
Geoffrey T. Manley
Dr. Geoffrey T. Manley, MD, PhD is Professor and Vice Chair of Neurosurgery at UCSF, Chief of Neurosurgery and Co-Director of the Brain and Spinal Injury Center at Zuckerberg San Francisco General Hospital. He received his MD and PhD from Cornell University and completed postdoctoral fellowships in molecular neuro-oncology at Memorial Sloan Kettering Cancer Center (New York City, NY, USA) and in molecular physics at the UCSF Cardiovascular Research Institute (San Francisco, CA, USA). He completed residency in Neurosurgery at UCSF. He is an internationally recognized expert in neurotrauma. He has helped to define new molecular mechanisms of brain injury and develp advanced neuromonitoring and clinical informatic tools for critical care. He is currently leading national and international efforts to create a modern knowledge warehouse that integrates clinical, imaging, proteomic, genomic, and outcome biomarkers of TBI to