Brain imaging as a predictor of early functional outcome following traumatic brain injury in children, adolescents, and young adults
A depth of lesion (DOL) model using brain imaging has been proposed to aid in medical decision-making and planning for rehabilitation resource needs. The purpose of this study was to determine the early prognostic value of a DOL classification system for children and young adults following severe tr...
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| Veröffentlicht in: | The journal of head trauma rehabilitation 2003-11, Vol.18 (6), p.493-503 |
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| container_title | The journal of head trauma rehabilitation |
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| creator | Blackman, James A Rice, Sydney A Matsumoto, Julie A Conaway, Mark R Elgin, Kevin M Patrick, Peter D Farrell, Walter J Allaire, Janet H Willson, Douglas F |
| description | A depth of lesion (DOL) model using brain imaging has been proposed to aid in medical decision-making and planning for rehabilitation resource needs. The purpose of this study was to determine the early prognostic value of a DOL classification system for children and young adults following severe traumatic brain injury.
CT/MRI brain imaging studies on 92 patients, aged 3 to 21, admitted to the Kluge Children's Rehabilitation Center, University of Virginia, were evaluated to determine DOL. Images were classified according to 5 DOL levels (cortical to brainstem). Functional outcomes in mobility, self-care, and cognition, as rated on the WeeFIM instrument, were compared by DOL levels.
Admission WeeFIM scores were significantly different for the DOL levels with the highest score for frontal and/or temporal lesions and the lowest for lesions including the brainstem or cerebellum (P |
| doi_str_mv | 10.1097/00001199-200311000-00003 |
| format | Article |
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CT/MRI brain imaging studies on 92 patients, aged 3 to 21, admitted to the Kluge Children's Rehabilitation Center, University of Virginia, were evaluated to determine DOL. Images were classified according to 5 DOL levels (cortical to brainstem). Functional outcomes in mobility, self-care, and cognition, as rated on the WeeFIM instrument, were compared by DOL levels.
Admission WeeFIM scores were significantly different for the DOL levels with the highest score for frontal and/or temporal lesions and the lowest for lesions including the brainstem or cerebellum (P<.001). However, the deeper the lesion, the greater the functional gains (P=.05), resulting in discharge WeeFIM scores that were not significantly different across DOL levels. Patients with deeper lesions tended to have longer lengths of stay in rehabilitation but were able to "catch up" with patients who had more superficial lesions.
While relatively simple and convenient, the DOL classification system is limited in its usefulness as an early prognostic tool. It may not be possible to predict outcome in the early acute phase in the intensive care unit on the basis of standard brain imaging alone. Patients with deeper lesions may enter rehabilitation at a more impaired level but can make remarkable progress, though it may take longer than for less severely injured individuals.</description><identifier>ISSN: 0885-9701</identifier><identifier>EISSN: 1550-509X</identifier><identifier>DOI: 10.1097/00001199-200311000-00003</identifier><identifier>PMID: 14707879</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins Ovid Technologies</publisher><subject>Adolescent ; Adult ; Brain Injuries - diagnosis ; Brain Injuries - rehabilitation ; Child ; Child, Preschool ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Prognosis ; Tomography, X-Ray Computed ; Treatment Outcome</subject><ispartof>The journal of head trauma rehabilitation, 2003-11, Vol.18 (6), p.493-503</ispartof><rights>Copyright Aspen Publishers, Inc. Nov/Dec 2003</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c253t-6283151a4e84d470a617e8b42fe878618f54e52b27ddc9400993777aa00b3ea63</citedby><cites>FETCH-LOGICAL-c253t-6283151a4e84d470a617e8b42fe878618f54e52b27ddc9400993777aa00b3ea63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14707879$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Blackman, James A</creatorcontrib><creatorcontrib>Rice, Sydney A</creatorcontrib><creatorcontrib>Matsumoto, Julie A</creatorcontrib><creatorcontrib>Conaway, Mark R</creatorcontrib><creatorcontrib>Elgin, Kevin M</creatorcontrib><creatorcontrib>Patrick, Peter D</creatorcontrib><creatorcontrib>Farrell, Walter J</creatorcontrib><creatorcontrib>Allaire, Janet H</creatorcontrib><creatorcontrib>Willson, Douglas F</creatorcontrib><title>Brain imaging as a predictor of early functional outcome following traumatic brain injury in children, adolescents, and young adults</title><title>The journal of head trauma rehabilitation</title><addtitle>J Head Trauma Rehabil</addtitle><description>A depth of lesion (DOL) model using brain imaging has been proposed to aid in medical decision-making and planning for rehabilitation resource needs. The purpose of this study was to determine the early prognostic value of a DOL classification system for children and young adults following severe traumatic brain injury.
CT/MRI brain imaging studies on 92 patients, aged 3 to 21, admitted to the Kluge Children's Rehabilitation Center, University of Virginia, were evaluated to determine DOL. Images were classified according to 5 DOL levels (cortical to brainstem). Functional outcomes in mobility, self-care, and cognition, as rated on the WeeFIM instrument, were compared by DOL levels.
Admission WeeFIM scores were significantly different for the DOL levels with the highest score for frontal and/or temporal lesions and the lowest for lesions including the brainstem or cerebellum (P<.001). However, the deeper the lesion, the greater the functional gains (P=.05), resulting in discharge WeeFIM scores that were not significantly different across DOL levels. Patients with deeper lesions tended to have longer lengths of stay in rehabilitation but were able to "catch up" with patients who had more superficial lesions.
While relatively simple and convenient, the DOL classification system is limited in its usefulness as an early prognostic tool. It may not be possible to predict outcome in the early acute phase in the intensive care unit on the basis of standard brain imaging alone. Patients with deeper lesions may enter rehabilitation at a more impaired level but can make remarkable progress, though it may take longer than for less severely injured individuals.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Brain Injuries - diagnosis</subject><subject>Brain Injuries - rehabilitation</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Prognosis</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><issn>0885-9701</issn><issn>1550-509X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUctuFDEQtBCILAm_gKwcODHgtsdj-5hEvKRIXEDKbeSxPWFWHnvxQ2jvfDhedpNI9KXVrarqRyGEgbwHosQH0gJAqY4SwgBa1R1a7BnaAOek40TdPUcbIiXvlCBwhl7lvG0cJoC_RGfQCyKkUBv05zrpJeBl1fdLuMc6Y413ydnFlJhwnLHTye_xXIMpSwza41iLiavDc_Q-_j6QStJ11WUxeDqKhW1N-5aw-bl4m1x4h7WN3mXjQsmtCBbvYz3Ms9WXfIFezNpn9_qUz9GPTx-_33zpbr99_npzddsZylnpBioZcNC9k71tF-gBhJNTT2cnhRxAzrx3nE5UWGtUT4hSTAihNSETc3pg5-jtUXeX4q_qchnXpe3kvQ4u1jwK6BUbBG3Ay_-A21hTuz6PFJiiPUhoIHkEmRRzTm4ed6n9Me1HIOPBpvHBpvHRpn8t1qhvTvp1Wp19Ip58YX8BCuuOLw</recordid><startdate>200311</startdate><enddate>200311</enddate><creator>Blackman, James A</creator><creator>Rice, Sydney A</creator><creator>Matsumoto, Julie A</creator><creator>Conaway, Mark R</creator><creator>Elgin, Kevin M</creator><creator>Patrick, Peter D</creator><creator>Farrell, Walter J</creator><creator>Allaire, Janet H</creator><creator>Willson, Douglas F</creator><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>8BM</scope></search><sort><creationdate>200311</creationdate><title>Brain imaging as a predictor of early functional outcome following traumatic brain injury in children, adolescents, and young adults</title><author>Blackman, James A ; Rice, Sydney A ; Matsumoto, Julie A ; Conaway, Mark R ; Elgin, Kevin M ; Patrick, Peter D ; Farrell, Walter J ; Allaire, Janet H ; Willson, Douglas F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c253t-6283151a4e84d470a617e8b42fe878618f54e52b27ddc9400993777aa00b3ea63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Brain Injuries - diagnosis</topic><topic>Brain Injuries - rehabilitation</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Prognosis</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Blackman, James A</creatorcontrib><creatorcontrib>Rice, Sydney A</creatorcontrib><creatorcontrib>Matsumoto, Julie A</creatorcontrib><creatorcontrib>Conaway, Mark R</creatorcontrib><creatorcontrib>Elgin, Kevin M</creatorcontrib><creatorcontrib>Patrick, Peter D</creatorcontrib><creatorcontrib>Farrell, Walter J</creatorcontrib><creatorcontrib>Allaire, Janet H</creatorcontrib><creatorcontrib>Willson, Douglas F</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>ComDisDome</collection><jtitle>The journal of head trauma rehabilitation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Blackman, James A</au><au>Rice, Sydney A</au><au>Matsumoto, Julie A</au><au>Conaway, Mark R</au><au>Elgin, Kevin M</au><au>Patrick, Peter D</au><au>Farrell, Walter J</au><au>Allaire, Janet H</au><au>Willson, Douglas F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Brain imaging as a predictor of early functional outcome following traumatic brain injury in children, adolescents, and young adults</atitle><jtitle>The journal of head trauma rehabilitation</jtitle><addtitle>J Head Trauma Rehabil</addtitle><date>2003-11</date><risdate>2003</risdate><volume>18</volume><issue>6</issue><spage>493</spage><epage>503</epage><pages>493-503</pages><issn>0885-9701</issn><eissn>1550-509X</eissn><abstract>A depth of lesion (DOL) model using brain imaging has been proposed to aid in medical decision-making and planning for rehabilitation resource needs. The purpose of this study was to determine the early prognostic value of a DOL classification system for children and young adults following severe traumatic brain injury.
CT/MRI brain imaging studies on 92 patients, aged 3 to 21, admitted to the Kluge Children's Rehabilitation Center, University of Virginia, were evaluated to determine DOL. Images were classified according to 5 DOL levels (cortical to brainstem). Functional outcomes in mobility, self-care, and cognition, as rated on the WeeFIM instrument, were compared by DOL levels.
Admission WeeFIM scores were significantly different for the DOL levels with the highest score for frontal and/or temporal lesions and the lowest for lesions including the brainstem or cerebellum (P<.001). However, the deeper the lesion, the greater the functional gains (P=.05), resulting in discharge WeeFIM scores that were not significantly different across DOL levels. Patients with deeper lesions tended to have longer lengths of stay in rehabilitation but were able to "catch up" with patients who had more superficial lesions.
While relatively simple and convenient, the DOL classification system is limited in its usefulness as an early prognostic tool. It may not be possible to predict outcome in the early acute phase in the intensive care unit on the basis of standard brain imaging alone. Patients with deeper lesions may enter rehabilitation at a more impaired level but can make remarkable progress, though it may take longer than for less severely injured individuals.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins Ovid Technologies</pub><pmid>14707879</pmid><doi>10.1097/00001199-200311000-00003</doi><tpages>11</tpages></addata></record> |
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| subjects | Adolescent Adult Brain Injuries - diagnosis Brain Injuries - rehabilitation Child Child, Preschool Female Humans Magnetic Resonance Imaging Male Prognosis Tomography, X-Ray Computed Treatment Outcome |
| title | Brain imaging as a predictor of early functional outcome following traumatic brain injury in children, adolescents, and young adults |
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