Brain Imaging as a Predictor of Early Functional Outcome Following Traumatic Brain Injury in Children, Adolescents, and Young Adults

James A. Blackman, Sydney A Rice, Julie A. Matsumoto, Mark R. Conaway, Kevin M. Elgin, Peter D. Patrick, Walter J. Farrell, Janet H. Allaire, Douglas F. Willson

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objectives: A depth of lesion (DOL) model using brain imaging has been proposed to aid in medical decision-making and planning for rehabilitation resource needs. The purpose of this study was to determine the early prognostic value of a DOL classification system for children and young adults following severe traumatic brain injury. Methods and Outcome measures: CT/MRI brain imaging studies on 92 patients, aged 3 to 21, admitted to the Kluge Children's Rehabilitation Center, University of Virginia, were evaluated to determine DOL. Images were classified according to 5 DOL levels (cortical to brainstem). Functional outcomes in mobility, self-care, and cognition, as rated on the WeeFIM instrument, were compared by DOL levels. Results: Admission WeeFIM scores were significantly different for the DOL levels with the highest score for frontal and/or temporal lesions and the lowest for lesions including the brainstem or cerebellum (P < .001). However, the deeper the lesion, the greater the functional gains (P = .05), resulting in discharge WeeFIM scores that were not significantly different across DOL levels. Patients with deeper lesions tended to have longer lengths of stay in rehabilitation but were able to "catch up" with patients who had more superficial lesions. Conclusions: While relatively simple and convenient, the DOL classification system is limited in its usefulness as an early prognostic tool. It may not be possible to predict outcome in the early acute phase in the intensive care unit on the basis of standard brain imaging alone. Patients with deeper lesions may enter rehabilitation at a more impaired level but can make remarkable progress, though it may take longer than for less severely injured individuals.

Original languageEnglish (US)
Pages (from-to)493-503
Number of pages11
JournalJournal of Head Trauma Rehabilitation
Volume18
Issue number6
StatePublished - Nov 2003
Externally publishedYes

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Neuroimaging
Young Adult
Rehabilitation
Brain Stem
Rehabilitation Centers
Self Care
Cerebellum
Cognition
Intensive Care Units
Length of Stay
Outcome Assessment (Health Care)
Traumatic Brain Injury

Keywords

  • Functional outcome
  • Neuroimaging
  • Rehabilitation
  • Traumatic brain injury
  • WeeFIM

ASJC Scopus subject areas

  • Rehabilitation
  • Clinical Neurology
  • Health Professions(all)

Cite this

Blackman, J. A., Rice, S. A., Matsumoto, J. A., Conaway, M. R., Elgin, K. M., Patrick, P. D., ... Willson, D. F. (2003). Brain Imaging as a Predictor of Early Functional Outcome Following Traumatic Brain Injury in Children, Adolescents, and Young Adults. Journal of Head Trauma Rehabilitation, 18(6), 493-503.

Brain Imaging as a Predictor of Early Functional Outcome Following Traumatic Brain Injury in Children, Adolescents, and Young Adults. / Blackman, James A.; Rice, Sydney A; Matsumoto, Julie A.; Conaway, Mark R.; Elgin, Kevin M.; Patrick, Peter D.; Farrell, Walter J.; Allaire, Janet H.; Willson, Douglas F.

In: Journal of Head Trauma Rehabilitation, Vol. 18, No. 6, 11.2003, p. 493-503.

Research output: Contribution to journalArticle

Blackman, JA, Rice, SA, Matsumoto, JA, Conaway, MR, Elgin, KM, Patrick, PD, Farrell, WJ, Allaire, JH & Willson, DF 2003, 'Brain Imaging as a Predictor of Early Functional Outcome Following Traumatic Brain Injury in Children, Adolescents, and Young Adults', Journal of Head Trauma Rehabilitation, vol. 18, no. 6, pp. 493-503.
Blackman, James A. ; Rice, Sydney A ; Matsumoto, Julie A. ; Conaway, Mark R. ; Elgin, Kevin M. ; Patrick, Peter D. ; Farrell, Walter J. ; Allaire, Janet H. ; Willson, Douglas F. / Brain Imaging as a Predictor of Early Functional Outcome Following Traumatic Brain Injury in Children, Adolescents, and Young Adults. In: Journal of Head Trauma Rehabilitation. 2003 ; Vol. 18, No. 6. pp. 493-503.
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abstract = "Objectives: A depth of lesion (DOL) model using brain imaging has been proposed to aid in medical decision-making and planning for rehabilitation resource needs. The purpose of this study was to determine the early prognostic value of a DOL classification system for children and young adults following severe traumatic brain injury. Methods and Outcome measures: CT/MRI brain imaging studies on 92 patients, aged 3 to 21, admitted to the Kluge Children's Rehabilitation Center, University of Virginia, were evaluated to determine DOL. Images were classified according to 5 DOL levels (cortical to brainstem). Functional outcomes in mobility, self-care, and cognition, as rated on the WeeFIM instrument, were compared by DOL levels. Results: Admission WeeFIM scores were significantly different for the DOL levels with the highest score for frontal and/or temporal lesions and the lowest for lesions including the brainstem or cerebellum (P < .001). However, the deeper the lesion, the greater the functional gains (P = .05), resulting in discharge WeeFIM scores that were not significantly different across DOL levels. Patients with deeper lesions tended to have longer lengths of stay in rehabilitation but were able to {"}catch up{"} with patients who had more superficial lesions. Conclusions: While relatively simple and convenient, the DOL classification system is limited in its usefulness as an early prognostic tool. It may not be possible to predict outcome in the early acute phase in the intensive care unit on the basis of standard brain imaging alone. Patients with deeper lesions may enter rehabilitation at a more impaired level but can make remarkable progress, though it may take longer than for less severely injured individuals.",
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