Neuroanesthesia & neurocritical care
Magnetic Resonance Imaging (MRI) and Clinical Variables for Prediction of Outcomes After Pediatric Severe Traumatic Brain Injury
Authors' conclusion
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.
Study context
- Population
- Children (<18 years) with severe traumatic brain injury (TBI) (Glasgow Coma Scale (GCS) ≤8) and ICP monitoring, MRI within 30 days of injury, 24 sites in US, UK and Australiamedian age 6.9 years
- Participants
- 233 children
- Comparison
- MRI + IMPACT vs IMPACT
- Outcome
- GOSE-Peds score
- Follow-up
- 3, 6, and 12 months after injury
Methodological detailspreplanned, using data from the and Decisions in Acute Pediatric TBI (ADAPT) prospective observational comparative effectiveness study, multicentre, Data collection, image analysis and data analyses completed in July 2023
- Preplanned, using data from the ADAPT prospective observational comparative effectiveness study
- Multicentre
- Data collection, image analysis and data analyses completed in July 2023
Performance
As reported in the abstract
Discrimination between favorable and unfavorable outcome (GOSE-Peds score >3) · 6 months after injury
| Test or model | AUC |
|---|---|
| MRI + IMPACT | 0.77 (95% CI, 0.72-0.85) |
| IMPACT | 0.67 (95% CI, 0.61-0.76) |
AUC
MRI + IMPACT0.77 (95% CI, 0.72-0.85)
IMPACT0.67 (95% CI, 0.61-0.76)
Further findings
Independent association with Glasgow Outcome Scale-Extended for Pediatrics (GOSE-Peds) score (multivariable model, MRI measures and IMPACT core variables)
| OR (95% CI) | ||
|---|---|---|
| Contusion volumeAll models adjusted for age and sex | 1.13 (1.02–1.26) | |
| Brain ischemiaAll models adjusted for age and sex | 2.11 (1.58–2.81) | |
| Brainstem lesionsAll models adjusted for age and sex | 5.40 (1.90–15.35) | |
| 0.050.21520Odds ratio (log scale) |
- Pupil reactivity also independently associated with GOSE-Peds score
Original publication
MRI and Clinical Variables for Prediction of Outcomes After Pediatric Severe Traumatic Brain Injury. JAMA Netw Open. Published 1 August 2024. doi:10.
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