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

Majdán, Marek; Bražinová, Alexandra; Rusňák, Martin; Leitgeb, Johannes

doi:10.4103/0976-3147.193543

Cited by 47 publications

(33 citation statements)

References 37 publications

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“…However, this lack of predictive power of the GCS score has been reported in other studies. Possible explanations include the influence of more aggressive pre hospital treatment obscuring GCS and causing difficulties in obtaining a valid neurological assessment during the first 24 h after trauma [ 34 , 35 ]. In addition, this study did not consider the pre-hospital care provided to these patients, the adequacy of the hospital resuscitation efforts, features of ICU care provided and features of post-ICU hospital stay.…”

Section: Discussionmentioning

confidence: 99%

Traumatic brain injury (TBI) outcomes in an LMIC tertiary care centre and performance of trauma scores

Samanamalee¹,

Sigera

Silva

et al. 2018

BMC Anesthesiol

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BackgroundThis study evaluates post-ICU outcomes of patients admitted with moderate and severe Traumatic Brain Injury (TBI) in a tertiary neurocritical care unit in an low middle income country and the performance of trauma scores: A Severity Characterization of Trauma, Trauma and Injury Severity Score, Injury Severity Score and Revised Trauma Score in this setting.MethodsAdult patients directly admitted to the neurosurgical intensive care units of the National Hospital of Sri Lanka between 21st July 2014 and 1st October 2014 with moderate or severe TBI were recruited.A telephone administered questionnaire based on the Glasgow Outcome Scale Extended (GOSE) was used to assess functional outcome of patients at 3 and 6 months after injury. The economic impact of the injury was assessed before injury, and at 3 and 6 months after injury.ResultsOne hundred and one patients were included in the study. Survival at ICU discharge, 3 and 6 months after injury was 68.3%, 49.5% and 45.5% respectively. Of the survivors at 3 months after injury, 43 (86%) were living at home. Only 19 (38%) patients had a good recovery (as defined by GOSE 7 and 8). Three months and six months after injury, respectively 25 (50%) and 14 (30.4%) patients had become “economically dependent”. Selected trauma scores had poor discriminatory ability in predicting mortality.ConclusionsThis observational study of patients sustaining moderate or severe TBI in Sri Lanka (a LMIC) reveals only 46% of patients were alive at 6 months after ICU discharge and only 20% overall attained a good (GOSE 7 or 8) recovery. The social and economic consequences of TBI were long lasting in this setting. Injury Severity Score, Revised Trauma Score, A Severity Characterization of Trauma and Trauma and Injury Severity Score, all performed poorly in predicting mortality in this setting and illustrate the need for setting adapted tools.

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Section: Discussionmentioning

confidence: 99%

Traumatic brain injury (TBI) outcomes in an LMIC tertiary care centre and performance of trauma scores

Samanamalee¹,

Sigera

Silva

et al. 2018

BMC Anesthesiol

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“… 14 18 26) For this reason, many suggest simpler prognostic models, such as Marschall-computed tomography (CT) score, Rotterdam CT score, abbreviated injury scale and Glasgow coma scale. 12 16 23 28) Majdan et al 15) compared the latter score systems to that of the others and revealed that there is no significant difference between them, meaning that either one of them could equally predict the concrete result.…”

Section: Discussionmentioning

confidence: 99%

Brain Trauma Mortality Rate Score Scale (BTMRSS): Postmortem Evaluation of the Events

Nikova

Dimitrov²

2020

Korean J Neurotrauma

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Objective Brain trauma and its burden is becoming a significant cause of permanent damage and deterioration. Prioritization at the place of the incident and calculation of mortality are leading factors for the final management, but all of them are obtained from living patients. When the autopsies are made there is no actual score system to guide the forensic scientists in their conclusions. Should all of the cadavers with traumatic brain injury (TBI) have been dead? Therefore, we aim to present a score system—brain trauma mortality score scale (BTMSS), aiming to evaluate postmortem the actual risk of mortality. Methods We established a score scale, which could be used on cadavers for the evaluation of the events. Afterwards, we applied this score scale on the reports of the cadavers who suffered blunt force TBI for a 10-year period of time between 2007 and 2016. Thereafter, the results were processed with SPSS version 25. Results The outcome showed that there is a significant difference between the scores of the cadavers who died at the place of the incident and those who died in hospital thus approving that the BTMSS works well, as well as the importance of level I trauma center. Conclusion Every score system could show something useful for the management of the TBIs. The solution and improvement in the outcome of the current study would be a level I trauma center with a qualified neurosurgical department.

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“…Future TBI severity classifications should not rely solely on clinical information, for the reasons discussed above. Severity classification should incorporate objective measures of pathophysiology such as neuroimaging and fluid biomarkers [ 45 , 46 , 47 ].…”

Section: A Proposal: From Severity Labels To Risk Assessment Over mentioning

confidence: 99%

Assessing the Severity of Traumatic Brain Injury—Time for a Change?

Tenovuo

Diaz‐Arrastia

Goldstein

et al. 2021

JCM

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Traumatic brain injury (TBI) has been described to be man’s most complex disease, in man’s most complex organ. Despite this vast complexity, variability, and individuality, we still classify the severity of TBI based on non-specific, often unreliable, and pathophysiologically poorly understood measures. Current classifications are primarily based on clinical evaluations, which are non-specific and poorly predictive of long-term disability. Brain imaging results have also been used, yet there are multiple ways of doing brain imaging, at different timepoints in this very dynamic injury. Severity itself is a vague concept. All prediction models based on combining variables that can be assessed during the acute phase have reached only modest predictive values for later outcome. Yet, these early labels of severity often determine how the patient is treated by the healthcare system at large. This opinion paper examines the problems and provides caveats regarding the use of current severity labels and the many practical and scientific issues that arise from doing so. The objective of this paper is to show the causes and consequences of current practice and propose a new approach based on risk classification. A new approach based on multimodal quantifiable data (including imaging and biomarkers) and risk-labels would be of benefit both for the patients and for TBI clinical research and should be a priority for international efforts in the field.

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

Cited by 47 publications

References 37 publications

Traumatic brain injury (TBI) outcomes in an LMIC tertiary care centre and performance of trauma scores

Traumatic brain injury (TBI) outcomes in an LMIC tertiary care centre and performance of trauma scores

Brain Trauma Mortality Rate Score Scale (BTMRSS): Postmortem Evaluation of the Events

Assessing the Severity of Traumatic Brain Injury—Time for a Change?

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