Correlation of Contusion Morphology and Volume With Functional Recovery and in Hospital Mortality in Traumatic Brain Injury.

Abstract

Objective: Traumatic cerebral contusions are one of the most clinically significant parenchymal lesions and contribute to great morbidity and mortality. Early identification of radiological factors associated with poor outcome can be helpful in early surgical intervention. To identify the association between contusion morphology and contusion volume and functional outcome and in-hospital mortality of patients suffering from traumatic cerebral contusions.

Methods: This prospective observational cohort study included 50 patients with traumatic brain injury and radiologically confirmed cerebral contusions. The Glasgow Coma Scale (GCS) was used and functional outcome at 6-month follow-up was measured as the Glasgow Outcome Scale (GOS). Contusions were evaluated on non-contrast computed tomography for morphology, anatomical location, depth, and volume. Associations between clinical and radiological variables and outcomes were reported using Spearman correlation, Kruskal-Wallis test, χ² test, and Fisher's exact test.

Results: The mean age was 32.2±11.5 years and 64.0% of patients were male. Fracture-associated contusions occurred in 54.0%, coup contusions in 66.0%, and herniation contusions in 20.0%. The frontal lobe was most commonly involved (22.0%). The mean contusion volume was 12.8±5.5 mL and the average admission GCS was 8.4±3.0. Decompressive craniectomy was also performed in 48.0% of the patients. Median GOS at follow-up was 3.0 and in-hospital mortality was 16.0%. Contusion volume was significantly associated with GOS (r=-0.760, p<0.001) and mortality.

Conclusion: In patients with traumatic cerebral contusions, a large volume of lesion, herniation-type appearance, and an unfavorable anatomical location were associated with poor functional outcome and in-hospital mortality.