The relation between Glasgow Coma Scale score and later cerebral atrophy in paediatric traumatic brain injury

E.B. Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, TX, USA.
Brain Injury (Impact Factor: 1.86). 04/2009; 23(3):228-33. DOI: 10.1080/02699050802672789
Source: PubMed

ABSTRACT To examine initial Glasgow Coma Scale (GCS) score and its relationship with later cerebral atrophy in children with traumatic brain injury (TBI) using Quantitative Magnetic Resonance Imaging (QMRI) at 4 months post-injury. It was hypothesized that a lower GCS score would predict later generalized atrophy. As a guide in assessing paediatric TBI patients, the probability of developing chronic cerebral atrophy was determined based on the initial GCS score.
The probability model used data from 45 paediatric patients (mean age = 13.6) with mild-to-severe TBI and 41 paediatric (mean age = 12.4) orthopaedically-injured children.
This study found a 24% increase in the odds of developing an abnormal ventricle-to-brain ratio (VBR) and a 27% increase in the odds of developing reduced white matter percentage on neuroimaging with each numerical drop in GCS score. Logistic regression models with cut-offs determined by normative QMRI data confirmed that a lower initial GCS score predicts later atrophy.
GCS is a commonly used measure of injury severity. It has proven to be a prognostic indicator of cognitive recovery and functional outcome and is also predictive of later parenchymal change.

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    • "For example, when severity classifi cation is made using the GCS or other similar procedures, some children initially classifi ed as having severe TBI do not demonstrate signifi cant neurocognitive or behavioral defi cits when examined after a period of recovery, and other factors including age at injury and premorbid functioning may account for more variance in neurocognitive outcomes (Fay et al., 2009 ; Lieh-Lai et al., 1992 ; Wells, Minnes, & Phillips, 2009 ). Indeed, the GCS has been described as only a gross predictor of TBI severity and functional outcome (Ghosh et al., 2009 ; Hackbarth et al., 2002 ; Hiekkanen, Kurki, Brandstack, Kairisto, & Tenovuo, 2009 ). Saatman et al. ( 2008 ) also point out that the GCS relies primarily on acute behavioral responses post-injury including best eye, verbal, and motor response, but provides little information about the pathophysiologic mechanisms underlying injury, which may provide additional insights on the nature and severity of the injury. "
    Cluster Analysis in Neuropsychological Research: Recent Applications, Edited by Daniel N. allen, Gerald Goldstein, 01/2013: chapter Classification of Traumatic Brain Injury Severity: A Neuropsychological Approach: pages 95-123; Springer Publishing Company., ISBN: 978-1461467434
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    • "When severity classification is made using the Glasgow Coma Scale (GCS; Teasdale & Jennet, 1974) or other similar procedures , many children initially classified as having severe TBI do not demonstrate significant neurocognitive deficits when examined after a period of recovery, and other factors including age at injury and clinical expertise may account for more variance in neurocognitive outcomes (Fay et al., 2009; Lieh-Lah, Theodorou, & Sarnaik, 1992; Wells, Minnes, & Phillips, 2009). Indeed, the GCS has been described as only a gross predictor of TBI severity and functional outcome (Ghosh et al., 2009; Hackbarth et al., 2002; Hiekkanen, Kurki, Brandstack, Kairisto, & Tenovuo, 2009). Given the associations between many neuropsychology measures and severity of brain damage, as well as associations between neurocognitive function and functional outcomes, neurocognitive profiles differentiated by IQ cluster subtypes may provide a different, and possibly more robust, method of classification, which may also show stronger associations with long-term behavioral and functional outcomes. "
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    ABSTRACT: Research suggests that IQ profiles identify subgroups of children with traumatic brain injury (TBI) based on sparing and impairment of cognitive abilities, but little information is available regarding whether these subgroups are differentiated on variables that are important for TBI outcome, such as behavioral functioning. The current study examined behavioral disturbances in 123 children with TBI in association with profiles of intellectual abilities identified using cluster analysis. On the basis of prior research, four clusters were hypothesized. Consistent with the hypothesis, cluster analysis identified four IQ clusters in the current sample. Comparisons among the clusters on behavior variables assessed from the Behavioral Assessment System for Children parent ratings indicated significant differences among the four IQ clusters, with the most impaired cluster exhibiting the severest disturbances. Results of the current study indicate that subgroups of children with TBI can be identified using IQ tests and that these subgroups are stable across different samples, and more importantly are moderately associated with behavioral disturbances that persist during the recovery period.
    Archives of Clinical Neuropsychology 09/2010; 25(8):781-90. DOI:10.1093/arclin/acq073 · 1.92 Impact Factor
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    • "Prefrontal regions are vulnerable due to their proximity to the sphenoidal ridges and bony protrusions on the base of the skull and gray matter in these regions has been found to be reduced even in the absence of focal lesions (Berryhill et al., 1995). MRI studies conducted several months to years post-injury have shown that loss of white matter can be extensive (Wilde et al., 2005; Ghosh et al., 2009; Bigler et al., 2010). Diffuse cortical thinning has been reported in children with moderate to severe TBI as compared to typically developing children (Merkley et al., 2008) or children with orthopedic injury (McCauley et al., 2010). "
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    ABSTRACT: Individuals with traumatic brain injury (TBI) exhibit deficits in executive control, which may impact their reasoning abilities. Analogical reasoning requires working memory and inhibitory abilities. In this study, we tested adolescents with moderate to severe TBI and typically developing (TD) controls on a set of picture analogy problems. Three factors were varied: complexity (number of relations in the problems), distraction (distractor item present or absent), and animacy (living or non-living items in the problems). We found that TD adolescents performed significantly better overall than TBI adolescents. There was also an age effect present in the TBI group where older participants performed better than younger ones. This age effect was not observed in the TD group. Performance was affected by complexity and distraction. Further, TBI participants exhibited lower performance with distractors present than TD participants. The reasoning deficits exhibited by the TBI participants were correlated with measures of executive function that required working memory updating, attention, and attentional screening. Using MRI-derived measures of cortical thickness, correlations were carried out between task accuracy and cortical thickness. The TD adolescents showed negative correlations between thickness and task accuracy in frontal and temporal regions consistent with cortical maturation in these regions. This study demonstrates that adolescent TBI results in impairments in analogical reasoning ability. Further, TBI youth have difficulty effectively screening out distraction, which may lead to failures in comprehension of the relations among items in visual scenes. Lastly, TBI youth fail to show robust cortical-behavior correlations as observed in TD individuals.
    Frontiers in Human Neuroscience 08/2010; 4. DOI:10.3389/fnhum.2010.00062 · 2.90 Impact Factor
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