Predicting Outcome 12 Months after Mild Traumatic Brain Injury in Patients Admitted to a Neurosurgery Service

Torgeir Hellstrøm, Tobias Kaufmann, Nada Andelic, Helene L Soberg, Solrun Sigurdardottir, Eirik Helseth, Ole A Andreassen, Lars T Westlye, Torgeir Hellstrøm, Tobias Kaufmann, Nada Andelic, Helene L Soberg, Solrun Sigurdardottir, Eirik Helseth, Ole A Andreassen, Lars T Westlye

Abstract

Objective: Accurate outcome prediction models for patients with mild traumatic brain injury (MTBI) are key for prognostic assessment and clinical decision-making. Using multivariate machine learning, we tested the unique and added predictive value of (1) magnetic resonance imaging (MRI)-based brain morphometric and volumetric characterization at 4-week postinjury and (2) demographic, preinjury, injury-related, and postinjury variables on 12-month outcomes, including global functioning level, postconcussion symptoms, and mental health in patients with MTBI.

Methods: A prospective, cohort study of patients (n = 147) aged 16-65 years with a 12-month follow-up. T1-weighted 3 T MRI data were processed in FreeSurfer, yielding accurate cortical reconstructions for surface-based analyses of cortical thickness, area, and volume, and brain segmentation for subcortical and global brain volumes. The 12-month outcome was defined as a composite score using a principal component analysis including the Glasgow Outcome Scale Extended, Rivermead Postconcussion Questionnaire, and Patient Health Questionnaire-9. Using leave-one-out cross-validation and permutation testing, we tested and compared three prediction models: (1) MRI model, (2) clinical model, and (3) MRI and clinical combined.

Results: We found a strong correlation between observed and predicted outcomes for the clinical model (r = 0.55, p < 0.001). The MRI model performed at the chance level (r = 0.03, p = 0.80) and the combined model (r = 0.45, p < 0.002) were slightly weaker than the clinical model. Univariate correlation analyses revealed the strongest association with outcome for postinjury factors of posttraumatic stress (Posttraumatic Symptom Scale-10, r = 0.61), psychological distress (Hospital Anxiety and Depression Scale, r = 0.52), and widespread pain (r = 0.43) assessed at 8 weeks.

Conclusion: We found no added predictive value of MRI-based measures of brain cortical morphometry and subcortical volumes over and above demographic and clinical features.

Keywords: cortical thickness; outcome; prediction; traumatic brain injury; volumetric analysis.

Figures

Figure 1
Figure 1
Flow diagram of mild traumatic brain injury (MTBI).
Figure 2
Figure 2
Association between predicted and observed outcome. (A) Imaging model mean squared error (MSE): 4.05, (B) clinical model MSE: 2.58, and (C) model with imaging + clinical data MSE: 2.91.

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