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McInnis C, Garcia MJS, Widjaja E, Frndova H, Huyse JV, Guerguerian AM, Oyefiade A, Laughlin S, Raybaud C, Miller E, Tay K, Bigler ED, Dennis M, Fraser DD, Campbell C, Choong K, Dhanani S, Lacroix J, Farrell C, Beauchamp MH, Schachar R, Hutchison JS, Wheeler AL. Magnetic Resonance Imaging Findings Are Associated with Long-Term Global Neurological Function or Death after Traumatic Brain Injury in Critically Ill Children. J Neurotrauma 2021; 38:2407-2418. [PMID: 33787327 DOI: 10.1089/neu.2020.7514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The identification of children with traumatic brain injury (TBI) who are at risk of death or poor global neurological functional outcome remains a challenge. Magnetic resonance imaging (MRI) can detect several brain pathologies that are a result of TBI; however, the types and locations of pathology that are the most predictive remain to be determined. Forty-two critically ill children with TBI were recruited prospectively from pediatric intensive care units at five Canadian children's hospitals. Pathologies detected on subacute phase MRIs included cerebral hematoma, herniation, cerebral laceration, cerebral edema, midline shift, and the presence and location of cerebral contusion or diffuse axonal injury (DAI) in 28 regions of interest were assessed. Global functional outcome or death more than 12 months post-injury was assessed using the Pediatric Cerebral Performance Category score. Linear modeling was employed to evaluate the utility of an MRI composite score for predicting long-term global neurological function or death after injury, and nonlinear Random Forest modeling was used to identify which MRI features have the most predictive utility. A linear predictive model of favorable versus unfavorable long-term outcomes was significantly improved when an MRI composite score was added to clinical variables. Nonlinear Random Forest modeling identified five MRI variables as stable predictors of poor outcomes: presence of herniation, DAI in the parietal lobe, DAI in the subcortical white matter, DAI in the posterior corpus callosum, and cerebral contusion in the anterior temporal lobe. Clinical MRI has prognostic value to identify children with TBI at risk of long-term unfavorable outcomes.
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Affiliation(s)
- Carter McInnis
- Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - María José Solana Garcia
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Neuroradiology, Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Helena Frndova
- Department of Critical Care Medicine, and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Judith Van Huyse
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne-Marie Guerguerian
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Critical Care Medicine, and Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Adeoye Oyefiade
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Suzanne Laughlin
- Division of Neuroradiology, Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, and Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Charles Raybaud
- Division of Neuroradiology, Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elka Miller
- Department of Medical Imaging, and Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Keng Tay
- Department of Radiology, London Health Sciences Centre, London, Ontario, Canada
| | - Erin D Bigler
- Department of Psychological Science and Neuroscience Centre, Brigham Young University, Provo, Utah, USA
| | - Maureen Dennis
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, and University of Toronto, Toronto, Ontario, Canada
| | - Douglas D Fraser
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Schulich School of Medicine University of Western Ontario, Children's Hospital of the London Health Sciences Centre and the Lawson Research Institute, London, Ontario, Canada
| | - Craig Campbell
- Division of Neurology, Children's Hospital of the London Health Sciences Centre and Department of Pediatrics, Epidemiology and Clinical Neurological Sciences, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Karen Choong
- Division of Pediatric Intensive Care, Department of Pediatrics, McMaster Children's Hospital-Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Sonny Dhanani
- Division of Pediatric Intensive Care, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jacques Lacroix
- Division of Pediatric Critical Care, CHU Sainte-Justine, Université de Montréal and Centre de Recherche du CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Catherine Farrell
- Division of Pediatric Critical Care, CHU Sainte-Justine, Université de Montréal and Centre de Recherche du CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Miriam H Beauchamp
- Division of Pediatric Critical Care, CHU Sainte-Justine, Université de Montréal and Centre de Recherche du CHU Sainte-Justine, Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Russell Schachar
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James S Hutchison
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Critical Care Medicine, and Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Anne L Wheeler
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
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