Feasibility of Online Traumatic Brain Injury Prognostic Corticosteroids Randomisation After Significant Head Injury (CRASH) Model as a Predictor of Mortality

Faried, Ahmad; Satriawan, Ferry C.; Arifin, Muhammad Z.

doi:10.1016/j.wneu.2018.04.180

Cited by 15 publications

(22 citation statements)

References 6 publications

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“…The first four studies concluded that the models show good performance on the validation datasets. The CRASH CT model was the most accurate among all the models when used to predict early mortality (14 days),27 29 and the IMPACT lab model was the most accurate to predict 6 months mortality and unfavourable outcome 26–28. However, the IMPACT models had poorer calibration, with an underestimation of mortality and unfavourable outcome when applied to the elderly population 28.…”

Section: Discussionmentioning

confidence: 98%

“…The IMPACT and CRASH models had been extensively validated in five observational studies conducted recently including (1) the prospective cohort study of severe TBI dataset of 587 cases in the USA,26 (2) the prospective cohort study using the national Neuroscience Institute data of 300 cases in Singapore,27 (3) dataset of 137 elderly patients with severe TBI from the retrospective cohort study in China,28 (4) the retrospective data of 229 moderate and severe TBI conducted in Java29 and (5) the retrospective cohort study of 127 patients with severe TBI who underwent decompressive craniectomy in a Colombian university hospital 30…”

Section: Discussionmentioning

confidence: 99%

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IMPACT and CRASH prognostic models for traumatic brain injury: external validation in a South-American cohort

et al. 2020

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ObjectiveTo develop a robust prognostic model, the more diverse the settings in which the system is tested and found to be accurate, the more likely it will be generalisable to untested settings. This study aimed to externally validate the International Mission for Prognosis and Clinical Trials in Traumatic Brain Injury (IMPACT) and Corticosteroid Randomization after Significant Head Injury (CRASH) models for low-income and middle-income countries using a dataset of patients with severe traumatic brain injury (TBI) from the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure study and a simultaneously conducted observational study.MethodA total of 550 patients with severe TBI were enrolled in the study, and 466 of those were included in the analysis. Patient admission characteristics were extracted to predict unfavourable outcome (Glasgow Outcome Scale: GOS<3) and mortality (GOS 1) at 14 days or 6 months.ResultsThere were 48% of the participants who had unfavourable outcome at 6 months and these included 38% who had died. The area under the receiver operating characteristic curve (AUC) values were 0.683–0.775 and 0.640–0.731 for the IMPACT and CRASH models respectively. The IMPACT CT model had the highest AUC for predicting unfavourable outcomes, and the IMPACT Lab model had the best discrimination for predicting 6-month mortality. The discrimination for both the IMPACT and CRASH models improved with increasing complexity of the models. Calibration revealed that there were disagreement between observed and predicted outcomes in the IMPACT and CRASH models.ConclusionThe overall performance of all IMPACT and CRASH models was adequate when used to predict outcomes in the dataset. However, some disagreement in calibration suggests the necessity for updating prognostic models to maintain currency and generalisability.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

IMPACT and CRASH prognostic models for traumatic brain injury: external validation in a South-American cohort

et al. 2020

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“…The International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) and the Corticosteroid Randomization after Significant Head Injury (CRASH) scores have been developed from large datasets and were externally validated to predict mortality and neurological outcome after traumatic brain injury (TBI) at 6 months [102–104]. Nevertheless, these scores are limited because functional recovery may continue for at least 18 months following TBI in some patients and because of the large heterogeneity in outcome prediction for an individual patient.…”

Section: Caring For the Injured Brain: Management Of Specific Patholomentioning

confidence: 99%

Update in Neurocritical Care: a summary of the 2018 Paris international conference of the French Society of Intensive Care

Oddo

Bracard

Cariou

et al. 2019

Ann. Intensive Care

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The 2018 Paris Intensive Care symposium entitled "Update in Neurocritical Care" was organized in Paris, June 21-22, 2018, under the auspices of the French Intensive Care Society. This 2-day postgraduate educational symposium comprised several chapters, aiming first to provide all-board intensivists with current standards for the clinical assessment of altered consciousness states (including coma and delirium) and peripheral nervous system in critically ill patients, monitoring of brain function (specifically, electro-encephalography) and best practices for sedation-analgesiadelirium management. An update on the treatment of specific severe brain pathologies-including ischaemic/ haemorrhagic stroke, cerebral venous thrombosis, hypoxic-ischaemic brain injury, immune-mediated and infectious encephalitis and refractory status epilepticus-was also provided. Finally, we discuss how to approach some difficult decisions, namely the role of decompressive craniectomy and prognostication models in patients with head injury. For each chapter, the scope of the present review was to provide important issues and key messages, provide most recent and relevant literature in the field, and briefly describe new developments in the field.

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“…Stein & Spettell, 1995), only partially capture the variability in cognitive, behavioral and social outcomes at acute and chronic stages following injury. In the early phase after injury, lower GCS score, older age, pupil dilatation, hypoxia, hypotension, and CT classifications based on the size of lesions and the degree of midline shift, provides some utility for predicting mortality and for categorization of patients into very broad outcome groups (Faried, Satriawan & Arifin, 2018;Maas et al, 2013;Steyerberg et al, 2008). However, this information is less valuable for evaluating patients presenting with less severe injuries or more fine-tuned prognostication of long-term neurobehavioral outcome.…”

Section: Leveraging Enigma To Address Challenges In Ams-tbi Researchmentioning

confidence: 99%

Toward a Global and Reproducible Science for Brain Imaging in Neurotrauma: The ENIGMA Adult Moderate/Severe Traumatic Brain Injury Working Group

Olsen¹,

Babikian²,

Bigler³

et al. 2019

Preprint

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The global burden of mortality and morbidity caused by traumatic brain injury (TBI) is significant and the heterogeneity of TBI patients and the relatively small sample sizes of most current neuroimaging studies is a major challenge for scientific advances and clinical translation. The ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Adult moderate/severe TBI (AMS-TBI) working group aims to be a driving force for new discoveries in AMS-TBI by providing researchers world-wide with an effective framework and platform for large-scale cross-border collaboration and data sharing. Based on the principles of transparency, rigor, reproducibility and collaboration, we will facilitate the development and dissemination of multiscale and big data analysis pipelines for harmonized analyses in AMS-TBI using structural and functional neuroimaging in combination with nonimaging biomarkers, genetics, as well as clinical and behavioral measures. Ultimately, we will offer investigators an unprecedented opportunity to test important hypotheses about recovery and morbidity in AMS-TBI by taking advantage of our robust methods for largescale neuroimaging data analysis. In this consensus statement we outline the working group’s short-term, intermediate, and long-term goals.

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Feasibility of Online Traumatic Brain Injury Prognostic Corticosteroids Randomisation After Significant Head Injury (CRASH) Model as a Predictor of Mortality

Cited by 15 publications

References 6 publications

IMPACT and CRASH prognostic models for traumatic brain injury: external validation in a South-American cohort

IMPACT and CRASH prognostic models for traumatic brain injury: external validation in a South-American cohort

Update in Neurocritical Care: a summary of the 2018 Paris international conference of the French Society of Intensive Care

Toward a Global and Reproducible Science for Brain Imaging in Neurotrauma: The ENIGMA Adult Moderate/Severe Traumatic Brain Injury Working Group

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