Early diagnosis of mortality using Admission CT perfusion in severe Traumatic Brain Injury patients (ACT-TBI study)

Severe traumatic brain injury (TBI) is a principal cause of post-injury hospitalization, disability, and death throughout the world primarily afflicting a young, healthy population with a previously excellent quality of life. In addition to being the leading cause of death and disability among people under 45 years of age, TBI represents the bulk of financial expenditure incurred by the different medical insurance companies for rehabilitation in Canada. TBI is predicted to be the most prevalent and costliest neurological condition in Canada through the year 2031. Outcome assessment after TBI is complex. Clinical examination of these patients are almost impossible as they are on life support and sedated at the time of their hospital admission. Roughly half of these patients who die, die in the first 48 hrs of hospital admission, despite receiving the most resource intensive treatment. These patients receive treatment despite lack of a clear understanding of their prognoses. We believe that some patients with severe TBI have a fatal brain injury at hospital admission, which is not recognized because of inadequate clinical examination. An advanced type of CT scan of brain called Computed Tomographic Perfusion (CTP) can establish brain death, when present. In a small pilot study, CTP done at the time of hospital admission, accurately diagnosed brain death in patients with severe TBI. The proposed research is to confirm these findings in a larger, powerful, well designed and a robust multi-center study. This study will directly address the existing lack of a routine robust neuroimaging test to improve diagnosis and prognosis of patients with severe TBI. This will provide a confident prognosis for the patients with severe TBI and optimize the use of health care resources by preventing the use of expensive intense care for potentially dead patients in the emergency room. Thereby this may improve trust and investment in organ donation in Canada and worldwide.