Outcomes of traumatic brain injury: the prognostic accuracy of various scores and models
Abstract
Introduction. Traumatic Brain Injury (TBI) is a worldwide health problem, and is a pathology that causes significant mortality and disability in Latin America. Different scores and prognostic models have been developed in order to predict the neurological outcomes of patients. We aimed to test the prognostic accuracy of the Marshall CT classification system, the Rotterdam CT scoring system, and the IMPACT and CRASH models, in predicting 6-month mortality and 6-month unfavourable outcomes in a cohort of trauma patients with TBI in a university hospital in Colombia. Methods. We analysed 309 patients with significant TBI who were treated in a regional trauma centre in Colombia over a two year period. Bivariate and multivariate analyses were undertaken. The discriminatory power of each model, as well as its accuracy and precision, were assessed by logistic regression and AUC. Shapiro Wilks, chi2 and Wilcoxon test were used to compare the actual outcomes in the cohort against the predicted outcomes. Results. The median age was 32 years, and 77.67% were male. All four prognostic models showed good accuracy in predicting outcomes. The IMPACT model had the greatest accuracy in predicting an unfavourable outcome (AUC 0.864; 95% CI 0.819 - 0.909) and in predicting mortality (AUC 0.902; 95% CI 0.862 - 0.943) in patients with TBI. Conclusion. All four prognostic models are applicable to eligible TBI patients in Colombia. The IMPACT model was shown to be more accurate than the other prognostic models, and had a higher sensitivity in predicting 6-month mortality and 6-month unfavourable outcomes in patients with TBI in a university hospital in Colombia.
Keywords: traumatic brain injuryprognosis modelsneurological outcome
References
- Byass P, de Courten M, Graham WJ, et al. Reflections on the global burden of disease 2010 estimates. PLoS Med. 2013; 10(7): e1001477.
- Horton R. GBD 2010: understanding disease, injury, and risk. Lancet. 2012; 380(9859): 2053–2054.
- Norton R, Kobusingye O. Injuries. New England Journal of Medicine. 2013; 368(18): 1723–1730.
- De la. Comportamiento del homicidio en Colombia, 2013. Forensis. ; 2013: 79–125.
- Maas AIR, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008; 7(8): 728–741.
- Ghajar J. Traumatic brain injury. The Lancet. 2000; 356(9233): 923–929.
- Perel P, Edwards P, Wentz R, et al. Systematic review of prognostic models in traumatic brain injury. BMC Med Inform Decis Mak. 2006; 6: 38.
- Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975; 1(7905): 480–484.
- Murray G, Butcher I, McHugh G, et al. Multivariable Prognostic Analysis in Traumatic Brain Injury: Results from The IMPACT Study. Journal of Neurotrauma. 2007; 24(2): 329–337.
- Perel P, Arango M, Clayton T, et al. MRC CRASH Trial Collaborators. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ. 2008; 336(7641): 425–429.
- Steyerberg EW, Mushkudiani N, Perel P, et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med. 2008; 5(8): e165; discussion e165.
- Roozenbeek B, Lingsma HF, Lecky FE, et al. International Mission on Prognosis Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) Study Group, Corticosteroid Randomisation After Significant Head Injury (CRASH) Trial Collaborators, Trauma Audit and Research Network (TARN). Prediction of outcome after moderate and severe traumatic brain injury: external validation of the International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) and Corticoid Randomisation After Significant Head injury (CRASH) prognostic models. Crit Care Med. 2012; 40(5): 1609–1617.
- Honeybul S, Ho KM, Lind CRP, et al. The retrospective application of a prediction model to patients who have had a decompressive craniectomy for trauma. J Neurotrauma. 2009; 26(12): 2179–2183.
- Honeybul S, Ho KM, Lind CRP, et al. Observed versus predicted outcome for decompressive craniectomy: a population-based study. J Neurotrauma. 2010; 27(7): 1225–1232.
- Marshall LF, Marshall SB, Klauber MR, et al. The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma. 1992; 9 Suppl 1: S287–S292.
- Maas AIR, Hukkelhoven CW, Marshall LF, et al. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery. 2005; 57(6): 1173–82; discussion 1173.
- Huang YH, Deng YH, Lee TC, et al. Rotterdam computed tomography score as a prognosticator in head-injured patients undergoing decompressive craniectomy. Neurosurgery. 2012; 71(1): 80–85.
- Honeybul S, Ho KM, Lind CRP, et al. Validation of the CRASH model in the prediction of 18-month mortality and unfavorable outcome in severe traumatic brain injury requiring decompressive craniectomy. J Neurosurg. 2014; 120(5): 1131–1137.
- Wong GK, Teoh J, Yeung J, et al. Outcomes of traumatic brain injury in Hong Kong: validation with the TRISS, CRASH, and IMPACT models. J Clin Neurosci. 2013; 20(12): 1693–1696.
- Egea-Guerrero JJ, Rodríguez-Rodríguez A, Gordillo-Escobar E, et al. IMPACT Score for Traumatic Brain Injury: Validation of the Prognostic Tool in a Spanish Cohort. J Head Trauma Rehabil. 2018; 33(1): 46–52.
- Panczykowski DM, Puccio AM, Scruggs BJ, et al. Prospective independent validation of IMPACT modeling as a prognostic tool in severe traumatic brain injury. J Neurotrauma. 2012; 29(1): 47–52.
- Hukkelhoven CW, Steyerberg EW, Habbema JD, et al. Predicting outcome after traumatic brain injury: development and validation of a prognostic score based on admission characteristics. J Neurotrauma. 2005; 22(10): 1025–1039.
- Honeybul S, Ho KM. Predicting long-term neurological outcomes after severe traumatic brain injury requiring decompressive craniectomy: A comparison of the CRASH and IMPACT prognostic models. Injury. 2016; 47(9): 1886–1892.
- Fraga H, Dourado I, Fernandes R, et al. Factores asociados a la incapacidad funcional global luego de transcurrido un año después del traumatismo craneoencefálico. Salud Colectiva. 2013; 9(3): 335.
- Andelic N, Sigurdardottir S, Arango-Lasprilla JC, et al. Long-Term Functional and Psychosocial Consequences and Health Care Provision after Traumatic Brain Injury. Behav Neurol. 2016; 2016: 2678081.
- Junqué C. Secuelas neuropsicológicas de los traumatismos craneoencefálicos. Revista de neurología. 1999; 28: 423–9.
- The effectiveness of psychological interventions for aggressive behavior following acquired brain injury: A meta-analysis and systematic review.
- Effective return-to-work interventions after acquired brain injury: A systematic review.
- A manual-based vocational rehabilitation program for patients with an acquired brain injury: study protocol of a pragmatic randomized controlled trial (RCT).
