Predictive utility of an adapted Marshall head CT classification scheme after traumatic brain injury

Allen W. Brown; Christopher R. Pretz; Kathleen R. Bell; Flora M. Hammond; David B. Arciniegas; Yelena G. Bodien; Kristen Dams-O’Connor; Joseph T. Giacino; Tessa Hart; Douglas Johnson-Greene; Robert G. Kowalski; William C. Walker; Alan Weintraub; Ross Zafonte

doi:10.1080/02699052.2019.1566970

Predictive utility of an adapted Marshall head CT classification scheme after traumatic brain injury

Allen W. Brown, Christopher R. Pretz, Kathleen R. Bell, Flora M. Hammond, David B. Arciniegas, Yelena G. Bodien, Kristen Dams-O’Connor, Joseph T. Giacino, Tessa Hart, Douglas Johnson-Greene, Robert G. Kowalski, William C. Walker, Alan Weintraub, Ross Zafonte

Research output: Contribution to journal › Article › peer-review

24 Scopus citations

Abstract

Objective: To study the predictive relationship among persons with traumatic brain injury (TBI) between an objective indicator of injury severity (the adapted Marshall computed tomography [CT] classification scheme) and clinical indicators of injury severity in the acute phase, functional outcomes at inpatient rehabilitation discharge, and functional and participation outcomes at 1 year after injury, including death. Participants: The sample involved 4895 individuals who received inpatient rehabilitation following acute hospitalization for TBI and were enrolled in the Traumatic Brain Injury Model Systems National Database between 1989 and 2014. Design: Head CT variables for each person were fit into adapted Marshall CT classification categories I through IV. Main Measures: Prediction models were developed to determine the amount of variability explained by the CT classification categories compared with commonly used predictors, including a clinical indicator of injury severity. Results: The adapted Marshall classification categories aided only in the prediction of craniotomy or craniectomy during acute hospitalization, otherwise making no meaningful contribution to variance in the multivariable models predicting outcomes at any time point after injury. Conclusion: Results suggest that head CT findings classified in this manner do not inform clinical discussions related to functional prognosis or rehabilitation planning after TBI.Abbreviations: CT: computed tomography; DRS: disability rating scale; EGOS: extended Glasgow outcome scale; FIM: functional independence measure; NDB: National Data Base; PTA: posttraumatic amnesia; RLOS: rehabilitation length of stay; SPOS: semipartial omega squared statistic; TBI: traumatic brain injury; TBIMS: Traumatic Brain Injury Model Systems.

Original language	English (US)
Pages (from-to)	610-617
Number of pages	8
Journal	Brain injury
Volume	33
Issue number	5
DOIs	https://doi.org/10.1080/02699052.2019.1566970
State	Published - Apr 16 2019

Keywords

Clinical decision-making
computed tomography
craniocerebral trauma
forecasting
neuroimaging

ASJC Scopus subject areas

Neuroscience (miscellaneous)
Developmental and Educational Psychology
Clinical Neurology

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Brown, A. W., Pretz, C. R., Bell, K. R., Hammond, F. M., Arciniegas, D. B., Bodien, Y. G., Dams-O’Connor, K., Giacino, J. T., Hart, T., Johnson-Greene, D., Kowalski, R. G., Walker, W. C., Weintraub, A., & Zafonte, R. (2019). Predictive utility of an adapted Marshall head CT classification scheme after traumatic brain injury. Brain injury, 33(5), 610-617. https://doi.org/10.1080/02699052.2019.1566970

Brown, AW, Pretz, CR, Bell, KR, Hammond, FM, Arciniegas, DB, Bodien, YG, Dams-O’Connor, K, Giacino, JT, Hart, T, Johnson-Greene, D, Kowalski, RG, Walker, WC, Weintraub, A & Zafonte, R 2019, 'Predictive utility of an adapted Marshall head CT classification scheme after traumatic brain injury', Brain injury, vol. 33, no. 5, pp. 610-617. https://doi.org/10.1080/02699052.2019.1566970

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abstract = "Objective: To study the predictive relationship among persons with traumatic brain injury (TBI) between an objective indicator of injury severity (the adapted Marshall computed tomography [CT] classification scheme) and clinical indicators of injury severity in the acute phase, functional outcomes at inpatient rehabilitation discharge, and functional and participation outcomes at 1 year after injury, including death. Participants: The sample involved 4895 individuals who received inpatient rehabilitation following acute hospitalization for TBI and were enrolled in the Traumatic Brain Injury Model Systems National Database between 1989 and 2014. Design: Head CT variables for each person were fit into adapted Marshall CT classification categories I through IV. Main Measures: Prediction models were developed to determine the amount of variability explained by the CT classification categories compared with commonly used predictors, including a clinical indicator of injury severity. Results: The adapted Marshall classification categories aided only in the prediction of craniotomy or craniectomy during acute hospitalization, otherwise making no meaningful contribution to variance in the multivariable models predicting outcomes at any time point after injury. Conclusion: Results suggest that head CT findings classified in this manner do not inform clinical discussions related to functional prognosis or rehabilitation planning after TBI.Abbreviations: CT: computed tomography; DRS: disability rating scale; EGOS: extended Glasgow outcome scale; FIM: functional independence measure; NDB: National Data Base; PTA: posttraumatic amnesia; RLOS: rehabilitation length of stay; SPOS: semipartial omega squared statistic; TBI: traumatic brain injury; TBIMS: Traumatic Brain Injury Model Systems.",

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doi = "10.1080/02699052.2019.1566970",

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AU - Arciniegas, David B.

AU - Bodien, Yelena G.

AU - Dams-O’Connor, Kristen

AU - Giacino, Joseph T.

AU - Hart, Tessa

AU - Johnson-Greene, Douglas

AU - Kowalski, Robert G.

AU - Walker, William C.

AU - Weintraub, Alan

AU - Zafonte, Ross

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N2 - Objective: To study the predictive relationship among persons with traumatic brain injury (TBI) between an objective indicator of injury severity (the adapted Marshall computed tomography [CT] classification scheme) and clinical indicators of injury severity in the acute phase, functional outcomes at inpatient rehabilitation discharge, and functional and participation outcomes at 1 year after injury, including death. Participants: The sample involved 4895 individuals who received inpatient rehabilitation following acute hospitalization for TBI and were enrolled in the Traumatic Brain Injury Model Systems National Database between 1989 and 2014. Design: Head CT variables for each person were fit into adapted Marshall CT classification categories I through IV. Main Measures: Prediction models were developed to determine the amount of variability explained by the CT classification categories compared with commonly used predictors, including a clinical indicator of injury severity. Results: The adapted Marshall classification categories aided only in the prediction of craniotomy or craniectomy during acute hospitalization, otherwise making no meaningful contribution to variance in the multivariable models predicting outcomes at any time point after injury. Conclusion: Results suggest that head CT findings classified in this manner do not inform clinical discussions related to functional prognosis or rehabilitation planning after TBI.Abbreviations: CT: computed tomography; DRS: disability rating scale; EGOS: extended Glasgow outcome scale; FIM: functional independence measure; NDB: National Data Base; PTA: posttraumatic amnesia; RLOS: rehabilitation length of stay; SPOS: semipartial omega squared statistic; TBI: traumatic brain injury; TBIMS: Traumatic Brain Injury Model Systems.

AB - Objective: To study the predictive relationship among persons with traumatic brain injury (TBI) between an objective indicator of injury severity (the adapted Marshall computed tomography [CT] classification scheme) and clinical indicators of injury severity in the acute phase, functional outcomes at inpatient rehabilitation discharge, and functional and participation outcomes at 1 year after injury, including death. Participants: The sample involved 4895 individuals who received inpatient rehabilitation following acute hospitalization for TBI and were enrolled in the Traumatic Brain Injury Model Systems National Database between 1989 and 2014. Design: Head CT variables for each person were fit into adapted Marshall CT classification categories I through IV. Main Measures: Prediction models were developed to determine the amount of variability explained by the CT classification categories compared with commonly used predictors, including a clinical indicator of injury severity. Results: The adapted Marshall classification categories aided only in the prediction of craniotomy or craniectomy during acute hospitalization, otherwise making no meaningful contribution to variance in the multivariable models predicting outcomes at any time point after injury. Conclusion: Results suggest that head CT findings classified in this manner do not inform clinical discussions related to functional prognosis or rehabilitation planning after TBI.Abbreviations: CT: computed tomography; DRS: disability rating scale; EGOS: extended Glasgow outcome scale; FIM: functional independence measure; NDB: National Data Base; PTA: posttraumatic amnesia; RLOS: rehabilitation length of stay; SPOS: semipartial omega squared statistic; TBI: traumatic brain injury; TBIMS: Traumatic Brain Injury Model Systems.

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Predictive utility of an adapted Marshall head CT classification scheme after traumatic brain injury

Abstract

Keywords

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