MRI and Clinical Variables for Prediction of Outcomes After Pediatric Severe Traumatic Brain Injury
Traumatic brain injury (TBI) is a leading cause of death and disability in children, and predicting functional outcome after TBI is challenging. Magnetic resonance imaging (MRI) is frequently conducted after severe TBI; however, the predictive value of MRI remains uncertain. To identify early MRI me...
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| creator | Ferrazzano, Peter A Rebsamen, Susan Field, Aaron S Broman, Aimee T Mayampurath, Anoop Rosario, Bedda Buttram, Sandra Willyerd, F Anthony Rathouz, Paul J Bell, Michael J Alexander, Andrew L |
| description | Traumatic brain injury (TBI) is a leading cause of death and disability in children, and predicting functional outcome after TBI is challenging. Magnetic resonance imaging (MRI) is frequently conducted after severe TBI; however, the predictive value of MRI remains uncertain.
To identify early MRI measures that predict long-term outcome after severe TBI in children and to assess the added predictive value of MRI measures over well-validated clinical predictors.
This preplanned prognostic study used data from the Approaches and Decisions in Acute Pediatric TBI (ADAPT) prospective observational comparative effectiveness study. The ADAPT study enrolled 1000 consecutive children (aged |
| doi_str_mv | 10.1001/jamanetworkopen.2024.25765 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11301548</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3142546686</sourcerecordid><originalsourceid>FETCH-LOGICAL-a347t-6dbef71296f868901dc3d165bdbd0846f42d0ea519ecd5d2ea4f9f3931707f353</originalsourceid><addsrcrecordid>eNpdkV1PFDEUhidGIgT4C6bRG2927ffMeGNwo7gJBKPobdNpT7XrTLu0HQz_nvIZ5Oo0fd_znp4-TfOG4CXBmLzf6EkHKP9i-hu3EJYUU76kopXiRbNXK1-wDouXT867zWHOG4wxxYT1UrxqdllPMKWy3WvM6fc10sGi1eiDN3pEv3TyehghIxcT-pbAelN8DCg6dDYXE6cqHbkCVayaLskb9AMuIQE6T3qedKkXn5L2Aa3DZk5XB82O02OGw_u63_z88vl89XVxcna8Xh2dLDTjbVlIO4BrCe2l62TXY2INs0SKwQ4Wd1w6Ti0GLUgPxgpLQXPXO9Yz0uLWMcH2m493udt5mMAaCCXpUW2Tn3S6UlF79b8S_B_1O14qQhgmgnc14d19QooXM-SiJp8NjGP98jhnxXDXCSn47bC3z6ybOKdQ91OMcCq4lJ2srg93LpNizgnc42sIVjc81TOe6oanuuVZm18_3eex9YEeuwbq9qH1</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3142546686</pqid></control><display><type>article</type><title>MRI and Clinical Variables for Prediction of Outcomes After Pediatric Severe Traumatic Brain Injury</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Ferrazzano, Peter A ; Rebsamen, Susan ; Field, Aaron S ; Broman, Aimee T ; Mayampurath, Anoop ; Rosario, Bedda ; Buttram, Sandra ; Willyerd, F Anthony ; Rathouz, Paul J ; Bell, Michael J ; Alexander, Andrew L</creator><creatorcontrib>Ferrazzano, Peter A ; Rebsamen, Susan ; Field, Aaron S ; Broman, Aimee T ; Mayampurath, Anoop ; Rosario, Bedda ; Buttram, Sandra ; Willyerd, F Anthony ; Rathouz, Paul J ; Bell, Michael J ; Alexander, Andrew L ; ADAPT MRI Investigators</creatorcontrib><description>Traumatic brain injury (TBI) is a leading cause of death and disability in children, and predicting functional outcome after TBI is challenging. Magnetic resonance imaging (MRI) is frequently conducted after severe TBI; however, the predictive value of MRI remains uncertain.
To identify early MRI measures that predict long-term outcome after severe TBI in children and to assess the added predictive value of MRI measures over well-validated clinical predictors.
This preplanned prognostic study used data from the Approaches and Decisions in Acute Pediatric TBI (ADAPT) prospective observational comparative effectiveness study. The ADAPT study enrolled 1000 consecutive children (aged <18 years) with severe TBI between February 1, 2014, and September 30, 2017. Participants had a Glasgow Coma Scale (GCS) score of 8 or less and received intracranial pressure monitoring. Magnetic resonance imaging scans performed as part of standard clinical care within 30 days of injury were collected at 24 participating sites in the US, UK, and Australia. Summary imaging measures were correlated with the Glasgow Outcome Scale-Extended for Pediatrics (GOSE-Peds), and the predictive value of MRI measures was compared with the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) core clinical predictors. Data collection, image analysis, and data analyses were completed in July 2023.
Pediatric severe TBI with an MRI scan performed as part of clinical care.
All measures were selected a priori. Magnetic resonance imaging measures included contusion, ischemia, diffuse axonal injury, intracerebral hemorrhage, and brainstem injury. Clinical predictors included the IMPACT core measures (GCS motor score and pupil reactivity). All models adjusted for age and sex. Outcome measures included the GOSE-Peds score obtained at 3, 6, and 12 months after injury.
This study included 233 children with severe TBI who were enrolled at participating sites and had an MRI scan and preselected clinical predictors available. Their median age was 6.9 (IQR, 3.0-13.3) years, and more than half of participants (134 [57.5%]) were male. In a multivariable model including MRI measures and IMPACT core clinical variables, contusion volume (odds ratio [OR], 1.13; 95% CI, 1.02-1.26), brain ischemia (OR, 2.11; 95% CI, 1.58-2.81), brainstem lesions (OR, 5.40; 95% CI, 1.90-15.35), and pupil reactivity were each independently associated with GOSE-Peds score. Adding MRI measures to the IMPACT clinical predictors significantly improved model fit and discrimination between favorable and unfavorable outcomes compared with IMPACT predictors alone (area under the receiver operating characteristic curve, 0.77; 95% CI, 0.72-0.85 vs 0.67; 95% CI, 0.61-0.76 for GOSE-Peds score >3 at 6 months after injury).
In this prognostic study of children with severe TBI, the addition of MRI measures significantly improved outcome prediction over well-established and validated clinical predictors. Magnetic resonance imaging should be considered in children with severe TBI to inform prognosis and may also promote stratification of patients in future clinical trials.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2024.25765</identifier><identifier>PMID: 39102267</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adolescent ; Australia ; Brain Injuries, Traumatic - diagnostic imaging ; Child ; Child, Preschool ; Clinical trials ; Contusions ; Female ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Infant ; Ischemia ; Magnetic resonance imaging ; Magnetic Resonance Imaging - methods ; Male ; Neurology ; Online Only ; Original Investigation ; Pediatrics ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Traumatic brain injury ; United Kingdom ; United States</subject><ispartof>JAMA network open, 2024-08, Vol.7 (8), p.e2425765</ispartof><rights>2024. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2024 Ferrazzano PA et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-a347t-6dbef71296f868901dc3d165bdbd0846f42d0ea519ecd5d2ea4f9f3931707f353</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,860,881,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39102267$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ferrazzano, Peter A</creatorcontrib><creatorcontrib>Rebsamen, Susan</creatorcontrib><creatorcontrib>Field, Aaron S</creatorcontrib><creatorcontrib>Broman, Aimee T</creatorcontrib><creatorcontrib>Mayampurath, Anoop</creatorcontrib><creatorcontrib>Rosario, Bedda</creatorcontrib><creatorcontrib>Buttram, Sandra</creatorcontrib><creatorcontrib>Willyerd, F Anthony</creatorcontrib><creatorcontrib>Rathouz, Paul J</creatorcontrib><creatorcontrib>Bell, Michael J</creatorcontrib><creatorcontrib>Alexander, Andrew L</creatorcontrib><creatorcontrib>ADAPT MRI Investigators</creatorcontrib><title>MRI and Clinical Variables for Prediction of Outcomes After Pediatric Severe Traumatic Brain Injury</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>Traumatic brain injury (TBI) is a leading cause of death and disability in children, and predicting functional outcome after TBI is challenging. Magnetic resonance imaging (MRI) is frequently conducted after severe TBI; however, the predictive value of MRI remains uncertain.
To identify early MRI measures that predict long-term outcome after severe TBI in children and to assess the added predictive value of MRI measures over well-validated clinical predictors.
This preplanned prognostic study used data from the Approaches and Decisions in Acute Pediatric TBI (ADAPT) prospective observational comparative effectiveness study. The ADAPT study enrolled 1000 consecutive children (aged <18 years) with severe TBI between February 1, 2014, and September 30, 2017. Participants had a Glasgow Coma Scale (GCS) score of 8 or less and received intracranial pressure monitoring. Magnetic resonance imaging scans performed as part of standard clinical care within 30 days of injury were collected at 24 participating sites in the US, UK, and Australia. Summary imaging measures were correlated with the Glasgow Outcome Scale-Extended for Pediatrics (GOSE-Peds), and the predictive value of MRI measures was compared with the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) core clinical predictors. Data collection, image analysis, and data analyses were completed in July 2023.
Pediatric severe TBI with an MRI scan performed as part of clinical care.
All measures were selected a priori. Magnetic resonance imaging measures included contusion, ischemia, diffuse axonal injury, intracerebral hemorrhage, and brainstem injury. Clinical predictors included the IMPACT core measures (GCS motor score and pupil reactivity). All models adjusted for age and sex. Outcome measures included the GOSE-Peds score obtained at 3, 6, and 12 months after injury.
This study included 233 children with severe TBI who were enrolled at participating sites and had an MRI scan and preselected clinical predictors available. Their median age was 6.9 (IQR, 3.0-13.3) years, and more than half of participants (134 [57.5%]) were male. In a multivariable model including MRI measures and IMPACT core clinical variables, contusion volume (odds ratio [OR], 1.13; 95% CI, 1.02-1.26), brain ischemia (OR, 2.11; 95% CI, 1.58-2.81), brainstem lesions (OR, 5.40; 95% CI, 1.90-15.35), and pupil reactivity were each independently associated with GOSE-Peds score. Adding MRI measures to the IMPACT clinical predictors significantly improved model fit and discrimination between favorable and unfavorable outcomes compared with IMPACT predictors alone (area under the receiver operating characteristic curve, 0.77; 95% CI, 0.72-0.85 vs 0.67; 95% CI, 0.61-0.76 for GOSE-Peds score >3 at 6 months after injury).
In this prognostic study of children with severe TBI, the addition of MRI measures significantly improved outcome prediction over well-established and validated clinical predictors. Magnetic resonance imaging should be considered in children with severe TBI to inform prognosis and may also promote stratification of patients in future clinical trials.</description><subject>Adolescent</subject><subject>Australia</subject><subject>Brain Injuries, Traumatic - diagnostic imaging</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Clinical trials</subject><subject>Contusions</subject><subject>Female</subject><subject>Glasgow Coma Scale</subject><subject>Glasgow Outcome Scale</subject><subject>Humans</subject><subject>Infant</subject><subject>Ischemia</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Neurology</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Pediatrics</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Traumatic brain injury</subject><subject>United Kingdom</subject><subject>United States</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkV1PFDEUhidGIgT4C6bRG2927ffMeGNwo7gJBKPobdNpT7XrTLu0HQz_nvIZ5Oo0fd_znp4-TfOG4CXBmLzf6EkHKP9i-hu3EJYUU76kopXiRbNXK1-wDouXT867zWHOG4wxxYT1UrxqdllPMKWy3WvM6fc10sGi1eiDN3pEv3TyehghIxcT-pbAelN8DCg6dDYXE6cqHbkCVayaLskb9AMuIQE6T3qedKkXn5L2Aa3DZk5XB82O02OGw_u63_z88vl89XVxcna8Xh2dLDTjbVlIO4BrCe2l62TXY2INs0SKwQ4Wd1w6Ti0GLUgPxgpLQXPXO9Yz0uLWMcH2m493udt5mMAaCCXpUW2Tn3S6UlF79b8S_B_1O14qQhgmgnc14d19QooXM-SiJp8NjGP98jhnxXDXCSn47bC3z6ybOKdQ91OMcCq4lJ2srg93LpNizgnc42sIVjc81TOe6oanuuVZm18_3eex9YEeuwbq9qH1</recordid><startdate>20240801</startdate><enddate>20240801</enddate><creator>Ferrazzano, Peter A</creator><creator>Rebsamen, Susan</creator><creator>Field, Aaron S</creator><creator>Broman, Aimee T</creator><creator>Mayampurath, Anoop</creator><creator>Rosario, Bedda</creator><creator>Buttram, Sandra</creator><creator>Willyerd, F Anthony</creator><creator>Rathouz, Paul J</creator><creator>Bell, Michael J</creator><creator>Alexander, Andrew L</creator><general>American Medical Association</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>7X8</scope><scope>5PM</scope></search><sort><creationdate>20240801</creationdate><title>MRI and Clinical Variables for Prediction of Outcomes After Pediatric Severe Traumatic Brain Injury</title><author>Ferrazzano, Peter A ; Rebsamen, Susan ; Field, Aaron S ; Broman, Aimee T ; Mayampurath, Anoop ; Rosario, Bedda ; Buttram, Sandra ; Willyerd, F Anthony ; Rathouz, Paul J ; Bell, Michael J ; Alexander, Andrew L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a347t-6dbef71296f868901dc3d165bdbd0846f42d0ea519ecd5d2ea4f9f3931707f353</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adolescent</topic><topic>Australia</topic><topic>Brain Injuries, Traumatic - diagnostic imaging</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Clinical trials</topic><topic>Contusions</topic><topic>Female</topic><topic>Glasgow Coma Scale</topic><topic>Glasgow Outcome Scale</topic><topic>Humans</topic><topic>Infant</topic><topic>Ischemia</topic><topic>Magnetic resonance imaging</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Neurology</topic><topic>Online Only</topic><topic>Original Investigation</topic><topic>Pediatrics</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Traumatic brain injury</topic><topic>United Kingdom</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ferrazzano, Peter A</creatorcontrib><creatorcontrib>Rebsamen, Susan</creatorcontrib><creatorcontrib>Field, Aaron S</creatorcontrib><creatorcontrib>Broman, Aimee T</creatorcontrib><creatorcontrib>Mayampurath, Anoop</creatorcontrib><creatorcontrib>Rosario, Bedda</creatorcontrib><creatorcontrib>Buttram, Sandra</creatorcontrib><creatorcontrib>Willyerd, F Anthony</creatorcontrib><creatorcontrib>Rathouz, Paul J</creatorcontrib><creatorcontrib>Bell, Michael J</creatorcontrib><creatorcontrib>Alexander, Andrew L</creatorcontrib><creatorcontrib>ADAPT MRI Investigators</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>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ferrazzano, Peter A</au><au>Rebsamen, Susan</au><au>Field, Aaron S</au><au>Broman, Aimee T</au><au>Mayampurath, Anoop</au><au>Rosario, Bedda</au><au>Buttram, Sandra</au><au>Willyerd, F Anthony</au><au>Rathouz, Paul J</au><au>Bell, Michael J</au><au>Alexander, Andrew L</au><aucorp>ADAPT MRI Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>MRI and Clinical Variables for Prediction of Outcomes After Pediatric Severe Traumatic Brain Injury</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2024-08-01</date><risdate>2024</risdate><volume>7</volume><issue>8</issue><spage>e2425765</spage><pages>e2425765-</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><abstract>Traumatic brain injury (TBI) is a leading cause of death and disability in children, and predicting functional outcome after TBI is challenging. Magnetic resonance imaging (MRI) is frequently conducted after severe TBI; however, the predictive value of MRI remains uncertain.
To identify early MRI measures that predict long-term outcome after severe TBI in children and to assess the added predictive value of MRI measures over well-validated clinical predictors.
This preplanned prognostic study used data from the Approaches and Decisions in Acute Pediatric TBI (ADAPT) prospective observational comparative effectiveness study. The ADAPT study enrolled 1000 consecutive children (aged <18 years) with severe TBI between February 1, 2014, and September 30, 2017. Participants had a Glasgow Coma Scale (GCS) score of 8 or less and received intracranial pressure monitoring. Magnetic resonance imaging scans performed as part of standard clinical care within 30 days of injury were collected at 24 participating sites in the US, UK, and Australia. Summary imaging measures were correlated with the Glasgow Outcome Scale-Extended for Pediatrics (GOSE-Peds), and the predictive value of MRI measures was compared with the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) core clinical predictors. Data collection, image analysis, and data analyses were completed in July 2023.
Pediatric severe TBI with an MRI scan performed as part of clinical care.
All measures were selected a priori. Magnetic resonance imaging measures included contusion, ischemia, diffuse axonal injury, intracerebral hemorrhage, and brainstem injury. Clinical predictors included the IMPACT core measures (GCS motor score and pupil reactivity). All models adjusted for age and sex. Outcome measures included the GOSE-Peds score obtained at 3, 6, and 12 months after injury.
This study included 233 children with severe TBI who were enrolled at participating sites and had an MRI scan and preselected clinical predictors available. Their median age was 6.9 (IQR, 3.0-13.3) years, and more than half of participants (134 [57.5%]) were male. In a multivariable model including MRI measures and IMPACT core clinical variables, contusion volume (odds ratio [OR], 1.13; 95% CI, 1.02-1.26), brain ischemia (OR, 2.11; 95% CI, 1.58-2.81), brainstem lesions (OR, 5.40; 95% CI, 1.90-15.35), and pupil reactivity were each independently associated with GOSE-Peds score. Adding MRI measures to the IMPACT clinical predictors significantly improved model fit and discrimination between favorable and unfavorable outcomes compared with IMPACT predictors alone (area under the receiver operating characteristic curve, 0.77; 95% CI, 0.72-0.85 vs 0.67; 95% CI, 0.61-0.76 for GOSE-Peds score >3 at 6 months after injury).
In this prognostic study of children with severe TBI, the addition of MRI measures significantly improved outcome prediction over well-established and validated clinical predictors. Magnetic resonance imaging should be considered in children with severe TBI to inform prognosis and may also promote stratification of patients in future clinical trials.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>39102267</pmid><doi>10.1001/jamanetworkopen.2024.25765</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Australia Brain Injuries, Traumatic - diagnostic imaging Child Child, Preschool Clinical trials Contusions Female Glasgow Coma Scale Glasgow Outcome Scale Humans Infant Ischemia Magnetic resonance imaging Magnetic Resonance Imaging - methods Male Neurology Online Only Original Investigation Pediatrics Predictive Value of Tests Prognosis Prospective Studies Traumatic brain injury United Kingdom United States |
| title | MRI and Clinical Variables for Prediction of Outcomes After Pediatric Severe Traumatic Brain Injury |
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