Aneurysmal Subarachnoid Hemorrhages (aSAH), Brain Injury, Coma, Cardiac Arrest (CA), Traumatic Brain Injury (TBI)
Conditions
Keywords
Outcome prediction, Disorders of Consciousness, Coma,, MRI, Brain injury
Brief summary
The general objective of the comaScore project is to provide an external validation of the accuracy of the comaScore, a score derived from magnetic resonance imaging (MRI), to predict 1 year outcome of patients unresponsive to simple orders after traumatic brain injury (TBI), aneurysmal subarachnoid hemorrhages (aSAH) and cardiac arrest (CA) in the day 7 - day 45 period post brain injury.
Detailed description
The general objective of the comaScore project is to provide an external validation of the accuracy of the comaScore, a score derived from magnetic resonance imaging (MRI), to predict 1 year outcome of patients unresponsive to simple orders after traumatic brain injury (TBI), aneurysmal subarachnoid hemorrhages (aSAH) and cardiac arrest (CA) in the day 7 - day 45 period post brain injury. As recent studies reported late awakeners cases, even in cardiac arrest and, in contrary, that around 10% of patients with acute brain injury remain with permanent disorders of consciousness (DOC), the need of reliable prognosis tool at the early phase, while the patient is still in the ICU, is critical. ComaScore, based on the quantitative analysis of diffusion tensor imaging, was developed from a derivation cohort of 506 patients. It is much more performing than existing tools (IMPACT, OHCA) in this respect. This study aims to prospectively validate the predictive accuracy of comaScore to predict unfavorable outcome at 1-year after the first insult, in an independent sample (external validation). Unfavorable outcome is defined as a Glascow Outcome Scale Extended (GOSE) of 1 to 3. This scale ranges from 1 to 8. Scores of 1 to 3 correspond to death, vegetative state, minimally conscious state or bedridden.
Interventions
OTHERMRI sequence
An additional sequence to conventional MRI exam (Diffusion tensor imaging) lasting less than 10 min (depending on the MR scanner type and sequence used).
OTHERMRI
MRI exam
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Patient Inclusion criteria 1. Male or female subject of 18 years old or above 2. Affiliated to a social security system excluding Aide Médicale d'État (AME) 3. Hospitalized in an intensive care unit and requiring mechanical ventilation after TBI, aSAH or CA 4. Absence of response to simple orders not explained by sedation alone at inclusion 5. Patient within 7 to 45 days after onset of TBI, aSAH or CA 6. Scheduled MRI within 5 days after inclusion 7. Written informed consent to participate in the study must be obtained proxy/legal representative. Patient non-inclusion criteria 1. MRI unavailability between day 7 and day 45 after brain injury 2. Origin of coma other than CA, TBI or aSAH 3. Pre-existing serious brain disease prior to coma status 4. Contra-indication to perform MRI 5. Subject protected by the law (curatorship or tutorship) Patient secondary
Exclusion criteria
1. Consciousness recovery before MRI exam 2. Contra-indication to perform MRI (appeared / discovered after inclusion) Healthy controls Inclusion criteria 1. Male or female subject from 18 to 65 years 2. Affiliated to a social security system excluding Aide Médicale d'État (AME). 3. No history of previous brain disease 4. No contra-indication to perform an MRI. 5. No pregnancy 6. Voluntarily agrees to participate by providing written informed consent Healthy controls Non-Inclusion criteria 1\. Subject protected by the law (curatorship or tutorship)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The unfavorable outcome | 1 year after the initial brain injury | The unfavorable outcome is defined as a Glascow Outcome Scale Extended (GOSE) of 1 to 3. This scale ranges from 1 to 8. Scores of 1 to 3 correspond to death, vegetative state, minimally conscious state or bedridden. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Etiology-specific performances of the Comascore evaluation after cardiac arrest | 1 year after the initial brain injury | To assess the predictive accuracy of comaScore evaluated in the day 7 - day 45 period post brain injury to predict unfavorable outcome at 1-year after the first insult in patients admitted in ICU after CA or TBI or sSAH, that remain unresponsive to simple orders at least 7 days after brain injury. |
| Etiology-specific performances of the Comascore evaluation after traumatic brain injury | 1 year after the initial brain injury | To assess the predictive accuracy of comaScore evaluated in the day 7 - day 45 period post brain injury to predict unfavorable outcome at 1-year after the first insult in patients admitted in ICU after CA or TBI or sSAH, that remain unresponsive to simple orders at least 7 days after brain injury. |
| Etiology-specific performances of the Comascore evaluation after aneurysmal subarachnoid hemorrhages | 1 year after the initial brain injury | To assess the predictive accuracy of comaScore evaluated in the day 7 - day 45 period post brain injury to predict unfavorable outcome at 1-year after the first insult in patients admitted in ICU after CA or TBI or sSAH, that remain unresponsive to simple orders at least 7 days after brain injury. |
| Time-window-specific performances of the Comascore evaluation | day 7 to 15, day 16 to 25, day 26 to 35 or day 36 to 45 | To assess the impact of time from brain injury to MRI allowing to calculate comaScore on the predictive accuracy of comaScore (4 periods will be determined |
| Comparison between COMASCORE and IMPACT score after traumatic brain injury | 1 year after the initial brain injury | To test the statistical difference in predictive accuracy between comaScore evaluated in the day 7 - day 45 period post brain injury and OHCA or IMPACT or WFNS score to predict unfavorable outcome at 1-year after the first insult in patients admitted in ICU after CA or TBI or aSAH, respectively, that remain unresponsive to simple orders at least 7 days after brain injury. |
| Comparison between COMASCORE and WFNS score after aneurysmal subarachnoid hemorrhages | 1 year after the initial brain injury | To test the statistical difference in predictive accuracy between comaScore evaluated in the day 7 - day 45 period post brain injury and OHCA or IMPACT or WFNS score to predict unfavorable outcome at 1-year after the first insult in patients admitted in ICU after CA or TBI or aSAH, respectively, that remain unresponsive to simple orders at least 7 days after brain injury. |
| Comparison between COMASCORE and OHCA score after cardiac arrest | 1 year after the initial brain injury | To test the statistical difference in predictive accuracy between comaScore evaluated in the day 7 - day 45 period post brain injury and OHCA or IMPACT or WFNS score to predict unfavorable outcome at 1-year after the first insult in patients admitted in ICU after CA or TBI or aSAH, respectively, that remain unresponsive to simple orders at least 7 days after brain injury. |
Countries
France
Contacts
Primary ContactLouis, MD
Backup ContactPUYBASSET Louis, MD
Outcome results
None listed