Evidence map›Paper›PMID 41672813›Full record

ArticleInjury2026

Neuroworsening from a normal Glasgow Coma Scale Motor Score in the emergency department is an early predictor of neurosurgical intervention, hospital outcomes, and longitudinal disability in traumatic brain injury: A TRACK-TBI Study.

John K Yue, Allen Y Fu, Mahmoud M Elguindy, Thomas A van Essen, Shawn R Eagle, David J Caldwell, Mary J Vassar, Patrick J Belton, Christine J Gotthardt, Shubhayu Bhattacharyay and 25 more

Registry-linked trialAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Injury, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02119182 (Transforming Research and Clinical Knowledge in Traumatic Brain Injury), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02119182 completednot on this map

Transforming Research and Clinical Knowledge in Traumatic Brain Injury

TypeobservationalSponsorUniversity of California, San FranciscoRan2014 to 2020Enrolled2,996ConditionsTraumatic Brain InjuryArmsIn-Person Outcome Assessment, Phone Outcome Assessment, 3T Magnetic Resonance Imaging (MRI), Blood Draw for Plasma, DNA, Serum, RNA
3 · Its place in the literature

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

35 authors.

John K YueDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States; Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States. Electronic address: John.Yue@ucsf.edu.
Allen Y FuNew York University Grossman School of Medicine, New York, NY, United States.
Mahmoud M ElguindyDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.
Thomas A van EssenUniversity Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center, HAGA, Leiden and The Hague, the Netherlands; Department of Surgery, Division of Neurosurgery, QEII Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada.
Shawn R EagleDepartment of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
David J CaldwellDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.
Mary J VassarDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.
Patrick J BeltonDepartment of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, United States.
Christine J GotthardtDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.
Shubhayu BhattacharyayDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States; Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States; Harvard Medical School, Boston, MA, United States.
Jason E ChungDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.
Gabriela G SatrisDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.
Rick J G VreeburgUniversity Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center, HAGA, Leiden and The Hague, the Netherlands.
Andrea L C SchneiderDepartment of Neurology, University of Pennsylvania, Philadelphia, PA, United States.
Austin LuiCollege of Osteopathic Medicine, Touro University California, Vallejo, CA, United States.
Debbie Y MadhokDepartment of Emergency Medicine, University of California, San Francisco, San Francisco, CA, United States; Department of Neurology, University of California, San Francisco, San Francisco, CA, United States.
Cathra HalabiWeill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States; Department of Neurology, University of California, San Francisco, San Francisco, CA, United States.
Adam R FergusonDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States; Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.
Michael C HuangDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.
Phiroz E TaraporeDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.
Anthony M DiGiorgioDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States.
Amy J MarkowitzDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.
Claudia S RobertsonDepartment of Neurological Surgery, Baylor College of Medicine, Houston, TX, United States.
Pratik MukherjeeBrain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States; Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States.
Esther L YuhBrain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States; Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States.
Michael A McCreaDepartment of Neurological Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.
Ann-Christine DuhaimeDepartment of Neurological Surgery, Massachusetts General Hospital, Boston, MA, United States.
H E HinsonPhilip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States; Department of Neurology, University of California, San Francisco, San Francisco, CA, United States.
Ava M PuccioDepartment of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Alex B ValadkaDepartment of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States.
David O OkonkwoDepartment of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Xiaoying SunBiostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, San Diego, CA, United States.
Sonia JainBiostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, San Diego, CA, United States.
Geoffrey T ManleyDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States; Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.
TRACK-TBI InvestigatorsThe TRACK-TBI Investigators Author Block is provided in alphabetical order by last name at the end of the front matter.

Funding

Transforming Research and Clinical Knowledge in Traumatic Brain InjuryU01NS086090 · NINDS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI DIAZ-ARRASTIA, RAMON, GIACINO, JOSEPH THOMAS · 2013 to 2017
$19.1M
Transforming Traumatic Brain Injury Research and Clinical CareRC2NS069409 · NINDS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI MANLEY, GEOFFREY T · 2009 to 2011
$4.3M
NINDS NIH HHS RC2 NS069409NINDS NIH HHS U01 NS086090
6 · The paper itself

Abstract

objectiveNeuroworsening portends poor outcomes after traumatic brain injury (TBI) and is protocolized in intensive care unit (ICU) settings. The utility of neuroworsening assessments in non-ICU settings for intervention and prognostication requires further understanding. This study assessed relationships among neuroworsening in the emergency department (ED), clinicoradiological injury, blood-based biomarkers, neurosurgical interventions, and outcomes in TBI patients without Glasgow Coma Scale-Motor Score (GCS-M) impairment at ED arrival.

methodsAdult subjects from the 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI; ClinicalTrials.gov #NCT02119182) Study with ED arrival GCS-M = 6 and ED disposition GCS-M were analyzed. Neuroworsening was defined as ED disposition GCS-M < 6. Subjects received clinically-indicated head computed tomography (CT) scan within 24-hours (h) post-TBI. Clinical characteristics, acute plasma TBI biomarker levels (glial fibrillary acidic protein (GFAP), ubiquitin c-terminal hydrolase-L1 (UCH-L1); pg/ml), neurosurgical procedural interventions, hospital outcomes, and 3- and 6-month outcomes (Glasgow Outcome Scale-Extended (GOSE)) were compared. Multivariable logistic regressions examined predictors of neurosurgical interventions and unfavorable outcomes (GOSE ≤ 4) using adjusted odds ratios (AOR [95 % confidence intervals (CI)]). Cox proportional hazards model examined hospital discharge rate over time using adjusted hazard ratios (AHR).

resultsIn 1210 subjects, 36 (3.0 %) had ED neuroworsening. Neuroworsening was associated with features of more severe injuries, including ICU admission (91.7 % vs. 30.3 %, p < 0.0001), post-traumatic amnesia duration (>24 h: 26.7 % vs. 4.2 %, p < 0.0001), and traumatic intracranial injuries on CT (72.2 % vs. 39.7 %, p = 0.00020). Neuroworsening subjects had higher GFAP (median = 1400 [Q1-Q3:864-3663] vs. 306 [82-839], p < 0.0001) and UCH-L1 (median = 459 [287-1036] vs. 170 [94-322], p < 0.0001), neurosurgical procedural interventions (38.9 % vs. 2.1 %, p < 0.0001), in-hospital mortality (8.6 % vs. 1.0 %, p = 0.018), hospital length of stay (6.9 days [Q1-Q3:4.8-16.8] vs. 2.2 days [1.3-4.0], p < 0.0001), and 3- and 6-month unfavorable outcomes (26.1 % vs. 3.5 %, p = 0.00040; 26.1 % vs. 3.7 %, p = 0.00050). Neuroworsening independently predicted neurosurgical interventions (AOR = 18.7 [95 % CI: 7.9-44.1], p < 0.0001), lower discharge rate [AHR = 0.35 [0.24-0.50], p < 0.0001), 3-month unfavorable outcome (AOR = 9.8 [3.0-31.9], p = 0.00010), and 6-month unfavorable outcome (AOR = 11.0 [3.1-38.7], p = 0.00020).

conclusionsED neuroworsening is an early indicator of clinicoradiological TBI severity, and predicted neurosurgical procedural interventions, longer hospitalizations, and 3- and 6-month unfavorable outcomes. Higher blood-based TBI biomarker levels were associated with ED neuroworsening, suggesting their potential role to aid in the assessment of TBI patients at high risk of neurological deterioration.

Indexed as

Brain Injuries, TraumaticEmergency Service, HospitalNeurosurgical ProceduresAdultBiomarkersFemaleGlasgow Coma ScaleHumansIntensive Care UnitsMaleMiddle AgedPredictive Value of TestsPrognosisTomography, X-Ray ComputedTreatment OutcomeBiomarkersBiomarkersCraniocerebral traumaEmergency serviceGlasgow coma scaleHospitalMortalityNeurological examinationNeuroworseningPrognosis

Identifiers

PMID41672813
PMCPMC13331228

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.