Multivariable Prognostic Analysis in Traumatic Brain Injury: Results from The IMPACT Study

Abstract

We studied the prognostic value of a wide range of conventional and novel prognostic factors on admission after traumatic brain injury (TBI) using both univariate and multivariable analysis. The outcome measure was Glasgow Outcome Scale at 6 months after injury. Individual patient data were available on a cohort of 8686 patients drawn from eight randomized controlled trials and three observational studies. The most powerful independent prognostic variables were age, Glasgow Coma Scale (GCS) motor score, pupil response, and computerized tomography (CT) characteristics, including the Marshall CT classification and traumatic subarachnoid hemorrhage. Prothrombin time was also identified as a powerful independent prognostic factor, but it was only available for a limited number of patients coming from three of the relevant studies. Other important prognostic factors included hypotension, hypoxia, the eye and verbal components of the GCS, glucose, platelets, and hemoglobin. These results on prognostic factors will underpin future work on the IMPACT project, which is focused on the development of novel approaches to the design and analysis of clinical trials in TBI. In addition, the results provide pointers to future research, including further analysis of the prognostic value of prothrombin time, and the evaluation of the clinical impact of intervening aggressively to correct abnormalities in hemoglobin, glucose, and coagulation.

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

“…Nonneurological organ dysfunction is an important predictor 66 Early physiological derangements are known to be associated with worse outcomes, and their timely correction could influence recovery. [67][68][69] Consistent with this notion, one randomized controlled trial demonstrated that pre-hospital rapid sequence intubation (RSI) by paramedics increased the proportion of TBI patients with a favourable neurological recovery. 14 Pre-hospital RSI was routine practice in Southern Alberta even before the time period assessed in this study.…”

Assessment of White Matter Injury and Outcome in Severe Brain Trauma. A Prospective Multicenter Cohort

“…1 The most extensively validated scoring system for TBI outcome is the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) score. 2 It is based on a multivariate model that combines clinical, biochemical, and computed tomography (CT) variables at admission to provide a probabilistic estimate of the outcome at 6 months. The IMPACT score is accurate in predicting outcomes in populations of patients with moderate and severe TBI but has limited utility in making decisions regarding any individual patient.…”

Prevalence of persistent vegetative state in patients with severe traumatic brain injury and its trend during the past four decades: A meta-analysis

“…The prevalence of PVS at six months after onset may be irrelevant to age and gender in the included studies, but no study has reported the effect of age and sex on the prevalence of PVS. Age probably has an impact on the outcome of TBI because it is an important factor in some models predicting the prognosis after TBI (Boyd, Tolson, & Copes, 1987;Murray et al, 2007;Perel et al, 2008) Thus, the reason for the negative result may be that the number of included studies is limited, and most of the studies have a similar mean age (27-49.3 years) and gender composition (0.698-0.818). These factors make it less likely that a significant result can be drawn from the multiple meta-regression analysis.…”