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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2024; 43(03): e157-e163
DOI: 10.1055/s-0043-1776278
Original Article

Evaluation of Admission Brain Computed Tomography Findings to Predict the Long-term Outcomes of Patients with Traumatic Brain Injury

Avaliação de achados em tomografia de crânio admissional para predizer o prognóstico a longo prazo de paciente com trauma cranioencefálico
Rafael de Souza Dantas
1   Department of Medicine, Fundação Universidade Federal de Sergipe, Lagarto, SE, Brazil
,
Thais Cristina de Souza Melo
1   Department of Medicine, Fundação Universidade Federal de Sergipe, Lagarto, SE, Brazil
,
Isabella Fontes de Santana Lins
1   Department of Medicine, Fundação Universidade Federal de Sergipe, Lagarto, SE, Brazil
,
Letícia Adrielle dos Santos
1   Department of Medicine, Fundação Universidade Federal de Sergipe, Lagarto, SE, Brazil
,
José Nolasco de Carvalho Neto
1   Department of Medicine, Fundação Universidade Federal de Sergipe, Lagarto, SE, Brazil
,
Bruno Fernandes de Oliveira Santos
1   Department of Medicine, Fundação Universidade Federal de Sergipe, Lagarto, SE, Brazil
2   Department of Medicine, Universidade Tiradentes, Aracaju, SE, Brazil
3   Department of Neurosurgery, Hospital de Cirurgia, Aracaju, SE, Brazil
,
Robson Luis Oliveira de Amorim
4   Neurosurgery Service, Hopital Universitário Getúlio Vargas, Universidade Federal do Amazonas, Manaus, AM, Brazil
,
Arthur Maynart Pereira Oliveira 
1   Department of Medicine, Fundação Universidade Federal de Sergipe, Lagarto, SE, Brazil
2   Department of Medicine, Universidade Tiradentes, Aracaju, SE, Brazil
› Author Affiliations Funding The authors declare that they have received no funding for the performance of the present study.
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Abstract

Objective To evaluate the admission brain computed tomography (CT) scan findings in patients with traumatic brain injury (TBI) in a low- and middle-income country (LMIC) to predict long-term neurological outcomes.

Materials and Methods Patients admitted to a tertiary emergency hospital between March 2017 and April 2018 who had suffered a TBI and had undergone a brain CT scan within 12 hours of the trauma were prospectively evaluated. All of the patients who were hospitalized for at least 24 hours were contacted by phone after 12 months to evaluate their neurological condition.

Results We achieved a 12-month follow-up with 180 patients, most of them male (93.33%). The brain changes identified by CT, such as brain contusion (BC; p = 0.545), epidural hemorrhage (EDH; p = 0.968) and skull base fracture (SBF; p = 0.112) were not associated with worse neurological outcomes; however, subdural hemorrhage (SDH; p = 0.041), subarachnoid hemorrhage (SAH; p ≤ 0.001), brain swelling (BS; p ≤0.001), effacement of cortical sulci (ECS; p = 0.006), effacement of basal cisterns (EBC; p ≤0.001), depressed skull fracture (DSF; p = 0.017), and a brain midline shift > 5 mm (p = 0.028) were associated with worse outcomes.

Conclusion Findings such as SAH, BS and DSF were independent predictors of worse neurological outcomes. The rate of 70% of patients lost to follow-up shows the difficulties of conducting long-term research in LMICs.

Resumo

Objetivo Avaliar as variáveis de tomografia computadorizada (TC) cerebral admissional em pacientes com trauma cranioencefálico (TCE) em um país de baixa e média renda (PBMR) para prever os resultados neurológicos de longo prazo.

Materiais e Métodos Foram avaliados prospectivamente pacientes admitidos em um hospital terciário de emergência entre março de 2017 e abril de 2018, que sofreram TCE e realizaram tomografia de crânio em até 12 horas após o trauma. Todos os pacientes que permaneceram internados por pelo menos 24 horas foram contatados por telefone após 12 meses para avaliação de sua condição neurológica.

Resultados Conseguimos um acompanhamento de 12 meses com 180 pacientes, a maioria deles do sexo masculino (93,33%). As alterações cerebrais identificadas pela TC, como contusão cerebral (CC; p = 0,545), hemorragia peridural (HPD; p = 0,968) e fratura da base do crânio (FBC; p = 0,112) não foram associadas a piores desfechos neurológicos; no entanto, hemorragia subdural (HSD; p = 0,041), hemorragia subaracnóidea (HSA; p ≤0,001), edema cerebral (EC; p ≤0,001), apagamento de sulcos corticais (ASC; p = 0,006), apagamento de cisternas (AC; p ≤0,001), fratura craniana deprimida (FCD; p = 0,017) e desvio da linha média do cérebro > 5 mm (p = 0,028) foram associados a piores resultados.

Conclusão Achados como HSA, EC e FCD foram preditores independentes de piores desfechos neurológicos. A taxa de perda de acompanhamento de 70% indica as dificuldades de se conduzir pesquisas de longo prazo em PBMRs.

Keywords

traumatic brain injury - computed tomography - outcome - developing countries

Palavras-chave

lesão cerebral traumática - tomografia computadorizada - prognóstico - países em desenvolvimento

Ethical Considerations

The present study was approved by the Ethics Committee of Fundação Universidade Federal de Sergipe (in accordance with the Helsinki Declaration, revised in 1983), and all patients or their legal guardian/next of kin signed an informed consent form.


Authors Contribution

All authors contributed to the conception and design of the study. Material preparation and data collection and analysis were performed by RSD, TCSM, IFSL, JNCN, LAS, BFOS,RLOA, and AMPO. The first draft of the manuscript was written by RSD, and all authors commented on previous versions of the manuscript. The final draft of the manuscript was written by LAS. All authors read and approved the final manuscript.




Publication History

Received: 11 February 2023

Accepted: 21 June 2023

Article published online:
29 April 2024

© 2024. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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