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Absolute Contusion ...
Absolute Contusion Expansion Is Superior to Relative Expansion in Predicting Traumatic Brain Injury Outcomes : A Multi-Center Observational Cohort Study
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- Fletcher-Sandersjöö, Alexander (författare)
- Karolinska Institutet,Karolinska Univ Hosp, Dept Neurosurg, Stockholm, Sweden.;Karolinska Inst, Dept Clin Neurosci, Sect Perioperat Med & Intens Care, Stockholm, Sweden.;Karolinska Inst, Bioclinicum J5 20, S-17164 Solna, Sweden.
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- Svedung Wettervik, Teodor (författare)
- Uppsala universitet,Neurokirurgi
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- Tatter, Charles (författare)
- Karolinska Institutet,Karolinska Inst, Dept Clin Neurosci, Sect Perioperat Med & Intens Care, Stockholm, Sweden.;Stockholm Southern Hosp, Dept Radiol, Stockholm, Sweden.
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- Tjerkaski, Jonathan (författare)
- Karolinska Inst, Dept Clin Neurosci, Sect Perioperat Med & Intens Care, Stockholm, Sweden.
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- Nelson, David W. (författare)
- Karolinska Institutet,Karolinska Univ Hosp, Funct Perioperat Med & Intens Care, Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Sect Perioperat Med & Intens Care, Stockholm, Sweden.
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- Maegele, Marc (författare)
- Univ Witten Herdecke, Cologne Merheim Med Ctr, Dept Trauma & Orthoped Surg, Cologne, Germany.;Univ Witten Herdecke, Inst Res Operat Med, Cologne, Germany.
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- Svensson, Mikael (författare)
- Karolinska Univ Hosp, Dept Neurosurg, Stockholm, Sweden.;Karolinska Inst, Dept Clin Neurosci, Sect Perioperat Med & Intens Care, Stockholm, Sweden.
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- Lewén, Anders, 1965- (författare)
- Uppsala universitet,Neurokirurgi
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- Enblad, Per (författare)
- Karolinska Institutet,Uppsala universitet,Neurokirurgi
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- Bellander, Bo-Michael (författare)
- Karolinska Univ Hosp, Dept Neurosurg, Stockholm, Sweden.;Karolinska Inst, Dept Clin Neurosci, Sect Perioperat Med & Intens Care, Stockholm, Sweden.
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- Thelin, Eric Peter (författare)
- Karolinska Inst, Dept Clin Neurosci, Sect Perioperat Med & Intens Care, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Neurol, Stockholm, Sweden.
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Karolinska Institutet Karolinska Univ Hosp, Dept Neurosurg, Stockholm, Sweden;Karolinska Inst, Dept Clin Neurosci, Sect Perioperat Med & Intens Care, Stockholm, Sweden.;Karolinska Inst, Bioclinicum J5 20, S-17164 Solna, Sweden. (creator_code:org_t)
- Mary Ann Liebert, 2024
- 2024
- Engelska.
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Ingår i: Journal of Neurotrauma. - : Mary Ann Liebert. - 0897-7151 .- 1557-9042. ; 41:5-6, s. 705-713
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Abstract
Ämnesord
Stäng
- Contusion expansion (CE) is a potentially treatable outcome predictor in traumatic brain injury (TBI), and a suitable end-point for hemostatic therapy trials. However, there is no consensus on the definition of clinically relevant CE, both in terms of measurement criteria (absolute vs. relative volume increase) and cutoff values. In light of this, the aim of this study was to assess the predictive abilities of different CE definitions on outcome. We performed a multi-center observational cohort study of adults with moderate-to-severe TBI treated in an intensive care unit. The exposure of interest was CE, defined as the absolute and relative volume change between the first and second computed tomography scan. The primary outcome was the Glasgow Outcome Scale (GOS) at 6–12 months post-injury, dichotomized into unfavorable (GOS ≤3) or favorable (GOS ≥4). The secondary outcome was all-cause mortality. In total, 798 patients were included, with a median duration of 7.0 h between the first and second CT scan. The median absolute and relative CE was 1.5 mL (interquartile range [IQR] 0.1–8.3 mL) and 100% (IQR 10–530%), respectively. Both CE forms were independently associated with unfavorable GOS. Absolute CE outperformed relative CE in predicting both unfavorable GOS (area under the curve [AUC]: 0.65 vs. 0.60, p = 0.002) and all-cause mortality (AUC: 0.66 vs. 0.60, p = 0.003). For dichotomized CE, absolute cutoffs of 1–10 mL yielded the best results. We conclude that absolute CE demonstrates stronger outcome correlation than relative CE. In studies focusing on lesion progression in TBI, it may be advantageous to use absolute CE as the primary outcome metric. For dichotomized outcomes, cutoffs between 1 and 10 mL are suggested, depending on the desired sensitivity-specificity balance.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
Nyckelord
- contusion
- contusion expansion
- hematoma expansion
- lesion progression
- outcome
- traumatic brain injury
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- art (ämneskategori)
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Fletcher-Sanders ...
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Svedung Wettervi ...
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Tatter, Charles
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Tjerkaski, Jonat ...
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Nelson, David W.
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Maegele, Marc
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Svensson, Mikael
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Lewén, Anders, 1 ...
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Enblad, Per
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Bellander, Bo-Mi ...
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Thelin, Eric Pet ...
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