颅脑外伤(TBI)后的孤立性外伤性蛛网膜下腔出血(tSAH)在头部计算机断层扫描(CT)扫描中通常被认为是“轻度”损伤,减少了对额外工作的需求。然而,tSAH也是不完全恢复和不利结果的预测因子。本研究旨在评估急诊部门(ED)到达格拉斯哥昏迷量表(GCS)评分13-15并在CT上隔离的TSAH的TBI患者的CT隐匿性颅内损伤的特征。未来的,18个中心的转化研究和创伤性脑损伤研究的临床知识(TRACK-TBI;2014-2019年注册年)招募了参加ED的参与者,并在TBI的24小时(h)内接受了临床指示的头部CT。一部分TRACK-TBI参与者在24小时内进行了静脉穿刺,用于血浆胶质纤维酸性蛋白(GFAP)分析,并在伤后2周研究MRI。在目前的研究中,TRACK-TBI参与者年龄≥17岁,ED到达GCS13-15,初次头部CT孤立的tSAH,血浆GFAP水平,并对2周MRI数据进行分析。在57名参与者中,中位年龄为46.0岁[四分位数1~3(Q1-Q3):34~57],52.6%为男性.在ED处置时,12.3%出院回家,61.4%被送往医院病房,和26.3%的重症监护室。MRI确定CT隐匿性外伤性颅内病变占45.6%(57名参与者中有26名;1个其他病变类型:31.6%;2个其他病变类型:14.0%);在这26名患有CT隐匿性颅内病变的参与者中,65.4%有轴索损伤,42.3%硬膜下血肿,23.1%有脑挫裂伤。与没有CT隐匿性MRI病变的参与者相比,GFAP水平更高(中位数:630.6pg/ml,Q1-Q3:[172.4-941.2]vs.226.4[105.8-436.1],p=0.049),并与轴索损伤相关(编号:中位数226.7pg/ml[109.6-435.1],是:828.6pg/ml[204.0-1194.3],p=0.009)。我们的结果表明,头部CT上孤立的tSAH通常不是GCS13-15TBI中唯一的颅内外伤。我们队列中46%的患者(57名参与者中的26名)在MRI上有额外的CT隐匿性外伤性病变。血浆GFAP可能是鉴定其他CT隐匿性损伤的重要生物标志物,包括轴突损伤。鉴于我们的样本量适中,应谨慎解释这些发现,并等待较大研究的验证。
Isolated traumatic subarachnoid hemorrhage (tSAH) after traumatic brain injury (TBI) on head computed tomography (CT) scan is often regarded as a \"mild\" injury, with reduced need for additional workup. However, tSAH is also a predictor of incomplete recovery and unfavorable outcome. This
study aimed to evaluate the characteristics of CT-occult intracranial injuries on brain magnetic resonance imaging (MRI) scan in TBI patients with emergency department (ED) arrival Glasgow Coma Scale (GCS) score 13-15 and isolated tSAH on CT. The prospective, 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury
Study (TRACK-TBI; enrollment years 2014-2019) enrolled participants who presented to the ED and received a clinically-indicated head CT within 24 h of TBI. A subset of TRACK-TBI participants underwent venipuncture within 24 h for plasma glial fibrillary acidic protein (GFAP) analysis, and research MRI at 2-weeks post-injury. In the current
study, TRACK-TBI participants age ≥17 years with ED arrival GCS 13-15, isolated tSAH on initial head CT, plasma GFAP level, and 2-week MRI data were analyzed. In 57 participants, median age was 46.0 years [quartile 1 to 3 (Q1-Q3): 34-57] and 52.6% were male. At ED disposition, 12.3% were discharged home, 61.4% were admitted to hospital ward, and 26.3% to intensive care unit. MRI identified CT-occult traumatic intracranial lesions in 45.6% (26 of 57 participants; one additional lesion type: 31.6%; 2 additional lesion types: 14.0%); of these 26 participants with CT-occult intracranial lesions, 65.4% had axonal injury, 42.3% had subdural hematoma, and 23.1% had intracerebral contusion. GFAP levels were higher in participants with CT-occult MRI lesions compared with without (median: 630.6 pg/mL, Q1-Q3: [172.4-941.2] vs. 226.4 [105.8-436.1], p = 0.049), and were associated with axonal injury (no: median 226.7 pg/mL [109.6-435.1], yes: 828.6 pg/mL [204.0-1194.3], p = 0.009). Our results indicate that isolated tSAH on head CT is often not the sole intracranial traumatic injury in GCS 13-15 TBI. Forty-six percent of patients in our cohort (26 of 57 participants) had additional CT-occult traumatic lesions on MRI. Plasma GFAP may be an important biomarker for the identification of additional CT-occult injuries, including axonal injury. These findings should be interpreted cautiously given our small sample size and await validation from larger studies.