Neuroanesthesia & neurocritical care
Diagnosis of in-hospital mortality using admission CT perfusion in severe traumatic brain injury patients (ACT-TBI study)
Authors' conclusion
CTP features of non-survivable brain injury showed very high specificity and positive predictive value for diagnosing in-hospital mortality in patients with severe TBI.
Study context
- Population
- Adults with severe traumatic brain injury (TBI) undergoing whole head CT Perfusion (CTP) at first imaging195 analysed
- Participants
- 201 adults
- Comparison
- CTP vs CTA
- Outcome
- In-hospital mortality (binary)
Methodological detailsblinded independent neuroradiologist reading, CTP results not disclosed to clinical team
- Blinded independent neuroradiologist reading
- CTP results not disclosed to clinical team
Performance
As reported in the abstract
Diagnostic accuracy for in-hospital mortality
| Test or model | AUC | Sensitivity | Specificity | PPV | NPV | Accuracy |
|---|---|---|---|---|---|---|
| CTP | 0.67 | 33% | 100% | 100% | 80% | 82% |
| CTA | — not stated in the abstract | — not stated in the abstract | 100% | 100% | — not stated in the abstract | — not stated in the abstract |
AUC
CTP0.67
CTA— not stated in the abstract
Sensitivity
CTP33%
CTA— not stated in the abstract
Specificity
CTP100%
CTA100%
PPV
CTP100%
CTA100%
NPV
CTP80%
CTA— not stated in the abstract
Accuracy
CTP82%
CTA— not stated in the abstract
— not stated in the abstract
- In-hospital deaths meeting CTP non-survival criteria on admission (of 55)
- 17 (31%)
Further findings
Factors independently associated with in-hospital mortality
| OR (95% CI) | P value | ||
|---|---|---|---|
| ICH | 20.25 (7.08–71.80) | P < 0.001 | |
| GSW | 22.67 (3.66–257.5) | P = 0.003 | |
| 0.050.21520Odds ratio (log scale) |
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Factors independently associated with in-hospital mortalityAge, per decade | 1.77 (1.37–2.36) | P < 0.001 | |
| 0.512Odds ratio (log scale) |
In-hospital mortality (overall)
- Died during hospital stay
- 55 (28.2%)
Inter-rater reliability
- CTP kappa (poor to fair)
- 0.07 to 0.44
- CTA scales kappa (fair to substantial)
- 0.39 to 0.79
Safety
- Complications associated with CTP
- 0 · events
Original publication
Diagnosis of in-hospital mortality using admission CT perfusion in severe traumatic brain injury patients (ACT-TBI study). Crit Care. Published 1 May 2025. doi:10.
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