Deans' stroke musings: Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, November 8, 2016

Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury

If someone has done this for stroke it is impossible to tell because our fucking failures of stroke associations have not created a database of all stroke related research.
http://journals.lww.com/jtrauma/Abstract/publishahead/Volumetric_analysis_of_day_of_injury_computed.99321.aspx

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Journal of Trauma and Acute Care Surgery:

Post Acceptance: October 31, 2016

doi: 10.1097/TA.0000000000001263

Original Article: PDF Only

Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury.

Majercik, Sarah MD, MBA; Bledsoe, Joseph MD; Ryser, David MD; Hopkins, Ramona O. PhD; Fair, Joseph E. M.S.; Frost, R. Brock PhD; MacDonald, Joel MD; Barrett, Ryan MS; Horn, Susan PhD; Pisani, David MD; Bigler, Erin D. PhD; Gardner, Scott PA-C; Stevens, Mark MD; Larson, Michael J. PhD

Published Ahead-of-Print

Abstract

Introduction: Day-of-injury (DOI) brain lesion volumes in traumatic brain injury (TBI) patients are rarely used to predict long-term outcomes in the acute setting. The purpose of this study was to investigate the relationship between acute brain injury lesion volume and rehabilitation outcomes in patients with TBI at a Level One Trauma Center.

Methods: Patients with TBI who were admitted to our rehabilitation unit after the acute care trauma service from February 2009-July 2011 were eligible for the study. Demographic data and outcome variables including cognitive and motor FIM scores, length of stay (LOS) in the rehabilitation unit, and ability to return to home were obtained. DOI quantitative injury lesion volumes and degree of midline shift were obtained from day-of-injury (DOI) brain computed tomography (CT) scans. A multiple step-wise regression model including 13 independent variables was created. This model was used to predict post-rehabilitation outcomes, including FIM scores and ability to return to home. P<0 .05="" considered="" p="" significant.="" was="">

Results: 96 patients were enrolled in the study. Mean age was 43+/-21 years, admission Glasgow Coma Score 8.4+/-4.8, Injury Severity Score 24.7+/-9.9, and head Abbreviated Injury Scale score 3.73+/-0.97. Acute hospital length of stay (LOS) was 12.3+/-8.9 days and rehabilitation LOS was 15.9+/-9.3 days. Day-of-injury TBI lesion volumes were inversely associated with cognitive FIM scores at rehabilitation admission (p=0.004) and discharge (p=0.004) and inversely associated with ability to be discharged to home after rehabilitation (p=0.006).

Conclusion: In a cohort of patients with moderate to severe TBI requiring a rehabilitation unit stay after the acute care hospital stay, DOI brain injury lesion volumes are associated with worse cognitive FIM scores at the time of rehabilitation admission and discharge. Smaller injury volumes were associated with eventual discharge to home. Volumetric neuroimaging in the acute injury phase may improve surgeons' ultimate outcome predictions in TBI patients.

Level of Evidence/Study Type

Level V, case series, Prognostic/Epidemiological