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Outcome from Complicated versus Uncomplicated Mild Traumatic Brain Injury.

Iverson GL, Lange RT, Wäljas M, Liimatainen S, Dastidar P, Hartikainen KM, Soimakallio S, Ohman J - Rehabil Res Pract (2012)

Bottom Line: The patients with uncomplicated MTBIs had a median of 6.0 days (IQR = 0.75-14.75, range = 0-77) off work compared to a median of 36 days (IQR = 13.5-53, range = 3-315) for the complicated group.There were no significant differences between groups for any of the neurocognitive or self-report measures.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1.

ABSTRACT
Objective. To compare acute outcome following complicated versus uncomplicated mild traumatic brain injury (MTBI) using neurocognitive and self-report measures. Method. Participants were 47 patients who presented to the emergency department of Tampere University Hospital, Finland. All completed MRI scanning, self-report measures, and neurocognitive testing at 3-4 weeks after injury. Participants were classified into the complicated MTBI or uncomplicated MTBI group based on the presence/absence of intracranial abnormality on day-of-injury CT scan or 3-4 week MRI scan. Results. There was a large statistically significant difference in time to return to work between groups. The patients with uncomplicated MTBIs had a median of 6.0 days (IQR = 0.75-14.75, range = 0-77) off work compared to a median of 36 days (IQR = 13.5-53, range = 3-315) for the complicated group. There were no significant differences between groups for any of the neurocognitive or self-report measures. There were no differences in the proportion of patients who (a) met criteria for ICD-10 postconcussional disorder or (b) had multiple low scores on the neurocognitive measures. Conclusion. Patients with complicated MTBIs took considerably longer to return to work. They did not perform more poorly on neurocognitive measures or report more symptoms, at 3-4 weeks after injury compared to patients with uncomplicated MTBIs.

No MeSH data available.


Related in: MedlinePlus

Hemosiderin detected with multiecho susceptibility weighted imaging using a 3 Tesla scanner. Multiecho SWI image (Philips Achieva 3T; 5 echoes; voxel size = 0.32 × 0.32 × 0.75 mm3). Courtesy of Alexander Rauscher, Ph.D., UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver, Canada.
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fig1: Hemosiderin detected with multiecho susceptibility weighted imaging using a 3 Tesla scanner. Multiecho SWI image (Philips Achieva 3T; 5 echoes; voxel size = 0.32 × 0.32 × 0.75 mm3). Courtesy of Alexander Rauscher, Ph.D., UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver, Canada.

Mentions: As technology evolves, some researchers will be tempted to broaden the criteria for complicated MTBI. In the past, intracranial abnormalities were identified using CT or conventional MRI. With advancements in technology, smaller and smaller abnormalities can be detected using structural imaging. For example, the area of hemosiderin (iron-rich staining of tissue from an area with past blood) shown in Figure 1 using multiecho susceptibility weighted imaging (SWI) with 5 echoes [23, 24] on a 3 Tesla MRI scanner would be undetectable with a modern CT scan and would likely be missed using 1.5 or 3.0 Tesla MRI conventional sequences [25]. Therefore, in past studies this subject would be classified as having an uncomplicated MTBI, but in future studies this abnormality might qualify for classification as a complicated MTBI. However, this subject was actually a healthy control subject in one of our studies. He had no known history of an injury to his brain. Thus, not only might the criteria for a complicated MTBI evolve to include smaller and smaller abnormalities—but some of these abnormalities might not be related to the MTBI—thus resulting in misdiagnosis.


Outcome from Complicated versus Uncomplicated Mild Traumatic Brain Injury.

Iverson GL, Lange RT, Wäljas M, Liimatainen S, Dastidar P, Hartikainen KM, Soimakallio S, Ohman J - Rehabil Res Pract (2012)

Hemosiderin detected with multiecho susceptibility weighted imaging using a 3 Tesla scanner. Multiecho SWI image (Philips Achieva 3T; 5 echoes; voxel size = 0.32 × 0.32 × 0.75 mm3). Courtesy of Alexander Rauscher, Ph.D., UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver, Canada.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3345249&req=5

fig1: Hemosiderin detected with multiecho susceptibility weighted imaging using a 3 Tesla scanner. Multiecho SWI image (Philips Achieva 3T; 5 echoes; voxel size = 0.32 × 0.32 × 0.75 mm3). Courtesy of Alexander Rauscher, Ph.D., UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver, Canada.
Mentions: As technology evolves, some researchers will be tempted to broaden the criteria for complicated MTBI. In the past, intracranial abnormalities were identified using CT or conventional MRI. With advancements in technology, smaller and smaller abnormalities can be detected using structural imaging. For example, the area of hemosiderin (iron-rich staining of tissue from an area with past blood) shown in Figure 1 using multiecho susceptibility weighted imaging (SWI) with 5 echoes [23, 24] on a 3 Tesla MRI scanner would be undetectable with a modern CT scan and would likely be missed using 1.5 or 3.0 Tesla MRI conventional sequences [25]. Therefore, in past studies this subject would be classified as having an uncomplicated MTBI, but in future studies this abnormality might qualify for classification as a complicated MTBI. However, this subject was actually a healthy control subject in one of our studies. He had no known history of an injury to his brain. Thus, not only might the criteria for a complicated MTBI evolve to include smaller and smaller abnormalities—but some of these abnormalities might not be related to the MTBI—thus resulting in misdiagnosis.

Bottom Line: The patients with uncomplicated MTBIs had a median of 6.0 days (IQR = 0.75-14.75, range = 0-77) off work compared to a median of 36 days (IQR = 13.5-53, range = 3-315) for the complicated group.There were no significant differences between groups for any of the neurocognitive or self-report measures.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1.

ABSTRACT
Objective. To compare acute outcome following complicated versus uncomplicated mild traumatic brain injury (MTBI) using neurocognitive and self-report measures. Method. Participants were 47 patients who presented to the emergency department of Tampere University Hospital, Finland. All completed MRI scanning, self-report measures, and neurocognitive testing at 3-4 weeks after injury. Participants were classified into the complicated MTBI or uncomplicated MTBI group based on the presence/absence of intracranial abnormality on day-of-injury CT scan or 3-4 week MRI scan. Results. There was a large statistically significant difference in time to return to work between groups. The patients with uncomplicated MTBIs had a median of 6.0 days (IQR = 0.75-14.75, range = 0-77) off work compared to a median of 36 days (IQR = 13.5-53, range = 3-315) for the complicated group. There were no significant differences between groups for any of the neurocognitive or self-report measures. There were no differences in the proportion of patients who (a) met criteria for ICD-10 postconcussional disorder or (b) had multiple low scores on the neurocognitive measures. Conclusion. Patients with complicated MTBIs took considerably longer to return to work. They did not perform more poorly on neurocognitive measures or report more symptoms, at 3-4 weeks after injury compared to patients with uncomplicated MTBIs.

No MeSH data available.


Related in: MedlinePlus