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Outcome Prediction after Traumatic Brain Injury: Comparison of the Performance of Routinely Used Severity Scores and Multivariable Prognostic Models

医学 格拉斯哥昏迷指数 创伤性脑损伤 接收机工作特性 格拉斯哥结局量表 重症监护室 曲线下面积 金标准(测试) 头部受伤 内科学 损伤严重程度评分 急诊医学 外科 毒物控制 伤害预防 精神科
作者
Marek Majdán,Alexandra Bražinová,Martin Rusňák,Johannes Leitgeb
出处
期刊:Journal of Neurosciences in Rural Practice [Medknow]
卷期号:08 (01): 020-029 被引量:50
标识
DOI:10.4103/0976-3147.193543
摘要

Prognosis of outcome after traumatic brain injury (TBI) is important in the assessment of quality of care and can help improve treatment and outcome. The aim of this study was to compare the prognostic value of relatively simple injury severity scores between each other and against a gold standard model - the IMPACT-extended (IMP-E) multivariable prognostic model.For this study, 866 patients with moderate/severe TBI from Austria were analyzed. The prognostic performances of the Glasgow coma scale (GCS), GCS motor (GCSM) score, abbreviated injury scale for the head region, Marshall computed tomographic (CT) classification, and Rotterdam CT score were compared side-by-side and against the IMP-E score. The area under the receiver operating characteristics curve (AUC) and Nagelkerke's R2 were used to assess the prognostic performance. Outcomes at the Intensive Care Unit, at hospital discharge, and at 6 months (mortality and unfavorable outcome) were used as end-points.Comparing AUCs and R2s of the same model across four outcomes, only little variation was apparent. A similar pattern is observed when comparing the models between each other: Variation of AUCs <±0.09 and R2s by up to ±0.17 points suggest that all scores perform similarly in predicting outcomes at various points (AUCs: 0.65-0.77; R2s: 0.09-0.27). All scores performed significantly worse than the IMP-E model (with AUC > 0.83 and R2 > 0.42 for all outcomes): AUCs were worse by 0.10-0.22 (P < 0.05) and R2s were worse by 0.22-0.39 points.All tested simple scores can provide reasonably valid prognosis. However, it is confirmed that well-developed multivariable prognostic models outperform these scores significantly and should be used for prognosis in patients after TBI wherever possible.
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