Observational studyNeurocritical care2026
Prognostic Value of MRI Anatomical Radiologic Scores for One-Year Neurological Outcome After Severe Traumatic Brain Injury.
Observational study in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00577954 (Multimodal Magnetic Resonance), which is not on this map. Not yet cited in PubMed.
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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.
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Multimodal Magnetic Resonance (MRI) Development in Comatose Patients for an Algorithm in the Prediction of Consciousness Recovery
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18 authors.
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Abstract
backgroundSevere traumatic brain injury (sTBI) is a major cause of mortality and long-term disability, and early prognostic evaluation is essential to support therapeutic decision-making in intensive care. MRI is the reference imaging modality for detecting diffuse axonal injury (DAI), yet the prognostic accuracy and reproducibility of MRI-based radiologic scoring systems remain uncertain. This study aimed to compare the prognostic performance of five published MRI-based DAI scores for predicting 1-year neurological outcome, in a cohort of sTBI patients admitted to intensive care.
methodsWe analyzed adult patients with sTBI included in the prospective MRI-COMA cohort (NCT00577954). Inclusion criteria were age ≥ 18 years, admission to ICU for sTBI, and absence of command following within 7 days after sedation withdrawal. Brain MRI was performed between day 7 and day 35 post-injury using standardized T1, FLAIR, T2*/SWI, and diffusion-weighted sequences. Three blinded evaluators (one neurointensivist, two neuroradiologists) independently applied five radiologic scores (Adams, Firsching, Hamdeh, Stockholm, Trondheim). The primary endpoint was the ability of each MRI-based radiologic score to predict 1-year neurological outcome, dichotomized as favorable (GOSE 5-8) or unfavorable (GOSE 1-4). Inter-rater reliability was quantified using Cohen's and Fleiss' kappa coefficients.
resultsBetween 2007 and 2023, 443 patients were screened and 185 met eligibility criteria. At one year, 111 patients (59%) had an unfavorable outcome. The prognostic performance of the five MRI scores was moderate, with AUCs ranging from 0.60 [CI95 0.52-0.68] to 0.70 [CI95 0.63-0.77], with no significant differences across scores or raters even between the intensivist and radiologists. Inter-rater reliability was fair to moderate (Fleiss' κ = 0.28 [CI95 0.22-0.34] to 0.38 [CI95 0.33-0.43]).
conclusionConventional MRI-based scores have limited prognostic value and reproducibility in cases of sTBI and are therefore not suitable for accurate and objective neuroprognostication.
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