Importance A head computed tomography (CT) with positive results for acute intracranial hemorrhage is the gold-standard diagnostic biomarker for acute traumatic brain injury (TBI). In moderate to severe TBI (Glasgow Coma Scale [GCS] scores 3-12), some CT features have been shown to be associated with outcomes. In mild TBI (mTBI; GCS scores 13-15), distribution and co-occurrence of pathological CT features and their prognostic importance are not well understood. Objective To identify pathological CT features associated with adverse outcomes after mTBI. Design, Setting, and Participants The longitudinal, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study enrolled patients with TBI, including those 17 years and older with GCS scores of 13 to 15 who presented to emergency departments at 18 US level 1 trauma centers between February 26, 2014, and August 8, 2018, and underwent head CT imaging within 24 hours of TBI. Evaluations of CT imaging used TBI Common Data Elements. Glasgow Outcome Scale-Extended (GOSE) scores were assessed at 2 weeks and 3, 6, and 12 months postinjury. External validation of results was performed via the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Data analyses were completed from February 2020 to February 2021. Exposures Acute nonpenetrating head trauma. Main Outcomes and Measures Frequency, co-occurrence, and clustering of CT features; incomplete recovery (GOSE scores <8 vs 8); and an unfavorable outcome (GOSE scores <5 vs ≥5) at 2 weeks and 3, 6, and 12 months. Results In 1935 patients with mTBI (mean [SD] age, 41.5 [17.6] years; 1286 men [66.5%]) in the TRACK-TBI cohort and 2594 patients with mTBI (mean [SD] age, 51.8 [20.3] years; 1658 men [63.9%]) in an external validation cohort, hierarchical cluster analysis identified 3 major clusters of CT features: contusion, subarachnoid hemorrhage, and/or subdural hematoma; intraventricular and/or petechial hemorrhage; and epidural hematoma. Contusion, subarachnoid hemorrhage, and/or subdural hematoma features were associated with incomplete recovery (odds ratios [ORs] for GOSE scores <8 at 1 year: TRACK-TBI, 1.80 [95% CI, 1.39-2.33]; CENTER-TBI, 2.73 [95% CI, 2.18-3.41]) and greater degrees of unfavorable outcomes (ORs for GOSE scores <5 at 1 year: TRACK-TBI, 3.23 [95% CI, 1.59-6.58]; CENTER-TBI, 1.68 [95% CI, 1.13-2.49]) out to 12 months after injury, but epidural hematoma was not. Intraventricular and/or petechial hemorrhage was associated with greater degrees of unfavorable outcomes up to 12 months after injury (eg, OR for GOSE scores <5 at 1 year in TRACK-TBI: 3.47 [95% CI, 1.66-7.26]). Some CT features were more strongly associated with outcomes than previously validated variables (eg, ORs for GOSE scores <5 at 1 year in TRACK-TBI: neuropsychiatric history, 1.43 [95% CI .98-2.10] vs contusion, subarachnoid hemorrhage, and/or subdural hematoma, 3.23 [95% CI 1.59-6.58]). Findings were externally validated in 2594 patients with mTBI enrolled in the CENTER-TBI study. Conclusions and Relevance In this study, pathological CT features carried different prognostic implications after mTBI to 1 year postinjury. Some patterns of injury were associated with worse outcomes than others. These results support that patients with mTBI and these CT features need TBI-specific education and systematic follow-up.

中文翻译：

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与轻度创伤性脑损伤后不良结果相关的病理计算机断层扫描特征：在 CENTER-TBI 中进行外部验证的 TRACK-TBI 研究。

重要性 急性颅内出血阳性结果的头部计算机断层扫描 (CT) 是急性创伤性脑损伤 (TBI) 的金标准诊断生物标志物。在中度至重度 TBI（格拉斯哥昏迷量表 [GCS] 评分 3-12）中，一些 CT 特征已被证明与结果相关。在轻度 TBI（mTBI；GCS 评分 13-15）中，病理 CT 特征的分布和共现及其预后重要性尚不清楚。目的确定与 mTBI 后不良结局相关的病理 CT 特征。设计、设置和参与者 包括 2014 年 2 月 26 日至 2018 年 8 月 8 日期间在 18 个美国 1 级创伤中心就诊并在 TBI 后 24 小时内接受头部 CT 成像的 GCS 评分为 13 至 15 分的 17 岁及以上患者。CT 成像评估使用 TBI 通用数据元素。在伤后 2 周和 3、6 和 12 个月评估格拉斯哥结果量表扩展 (GOSE) 评分。通过欧洲脑外伤协作神经创伤有效性研究 (CENTER-TBI) 研究对结果进行了外部验证。数据分析于 2020 年 2 月至 2021 年 2 月完成。暴露急性非穿透性头部外伤。主要结果和测量 CT 特征的频率、共现和聚类；不完全恢复（GOSE 评分 <8 对 8）；和不利的结果（GOSE 评分 < 5 vs ≥5) 在 2 周和 3、6 和 12 个月。结果 TRACK-TBI 队列中的 1935 名 mTBI 患者（平均 [SD] 年龄，41.5 [17.6] 岁；1286 名男性 [66.5%]）和 2594 名 mTBI 患者（平均 [SD] 年龄，51.8 [20.3] 岁； 1658 名男性 [63.9%]）在外部验证队列中，分层聚类分析确定了 3 个主要的 CT 特征聚类：挫伤、蛛网膜下腔出血和/或硬膜下血肿；脑室内和/或瘀点出血；和硬膜外血肿。挫伤、蛛网膜下腔出血和/或硬膜下血肿特征与不完全恢复相关（1 年时 GOSE 评分 <8 的优势比 [ORs]：TRACK-TBI，1.80 [95% CI，1.39-2.33]；CENTER-TBI， 2.73 [95% CI, 2.18-3.41]）和更大程度的不利结果（1 年时 GOSE 评分 <5 的 OR：TRACK-TBI，3.23 [95% CI，1.59-6.58]；CENTER-TBI，1.68 [95 ％CI，1.13-2.49]) 到受伤后 12 个月，但硬膜外血肿没有。脑室内和/或瘀点出血与损伤后 12 个月内更大程度的不利结果相关（例如，在 TRACK-TBI 中，1 年时 GOSE 评分 < 5 的 OR：3.47 [95% CI，1.66-7.26]）。一些 CT 特征与结果的相关性比先前验证的变量更强烈（例如，TRACK-TBI 中 1 年时 GOSE 评分 <5 的 OR：神经精神病史，1.43 [95% CI .98-2.10] vs 挫伤、蛛网膜下腔出血和/ 或硬膜下血肿，3.23 [95% CI 1.59-6.58]）。结果在参加 CENTER-TBI 研究的 2594 名 mTBI 患者中得到了外部验证。结论和相关性 在本研究中，病理 CT 特征在 mTBI 至损伤后 1 年具有不同的预后意义。一些损伤模式与比其他模式更差的结果相关。这些结果支持 mTBI 患者和这些 CT 特征需要针对 TBI 的教育和系统的随访。