Predicting Outcome in Traumatic Brain Injury

Raj, Rahul; Siironen, Jari; Skrifvars, Markus B.; Hernesniemi, Juha; Kivisaari, Riku

doi:10.1227/neu.0000000000000533

Cited by 132 publications

(101 citation statements)

References 47 publications

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“…Another study comparing the M-CT and R-CT in a side-by-side manner found AUCs of 0.63 and 0.68 for 6 months unfavorable outcome and AUCs of 0.64 and 0.7 for 6 months mortality; the reported Nagelkerke's R 2 s were 0.09 and 0.16 for the prediction of 6 months unfavorable outcome and 0.09 and 0.15 for the prediction of 6 months mortality. [16] The performance indices reported in this study are similar to our findings and in favor of their comparability speaks the virtually the same line of statistical analysis that was followed in both studies (including optimism correction).…”

Section: Discussionsupporting

confidence: 88%

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

Majdán

Bražinová

Rusňák

et al. 2017

Journal of Neurosciences in Rural Practice

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Objectives: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.Materials and Methods: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.Results: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.Conclusions: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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Section: Discussionsupporting

confidence: 88%

“…Both, the M-CT and the R-CT, have been proven as valid tools for prognosis of patients after TBI. [1516]…”

Section: Introductionmentioning

confidence: 99%

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

Majdán

Bražinová

Rusňák

et al. 2017

Journal of Neurosciences in Rural Practice

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“…CT is consistently done on the day of injury (DOI), and then may or may not be repeated during the patient’s hospital stay. Scoring systems using CT findings such as the Marshall classification [6], the Rotterdam score [7], and most recently, the Helsinki score [8] have been developed, but these have primarily been found to be useful as predictors of mortality, as opposed to predicting long-term function. A limitation of the studies is that they primarily utilize a categorical CT abnormality classification system that relies heavily on neuroradiologist report, rather than direct examination of CT scans.…”

Section: Introductionmentioning

confidence: 99%

Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury

Majercik

Bledsoe

Ryser

et al. 2017

Journal of Trauma and Acute Care Surgery

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Introduction Day-of-injury (DOI) brain lesion volumes in traumatic brain injury (TBI) patients are rarely used to predict long-term outcomes in the acute setting. The purpose of this study was to investigate the relationship between acute brain injury lesion volume and rehabilitation outcomes in patients with TBI at a Level One Trauma Center. Methods Patients with TBI who were admitted to our rehabilitation unit after the acute care trauma service from February 2009-July 2011 were eligible for the study. Demographic data and outcome variables including cognitive and motor FIM scores, length of stay (LOS) in the rehabilitation unit, and ability to return to home were obtained. DOI quantitative injury lesion volumes and degree of midline shift were obtained from day-of-injury (DOI) brain computed tomography (CT) scans. A multiple step-wise regression model including 13 independent variables was created. This model was used to predict post-rehabilitation outcomes, including FIM scores and ability to return to home. P<0.05 was considered significant. Results 96 patients were enrolled in the study. Mean age was 43±21 years, admission Glasgow Coma Score 8.4±4.8, Injury Severity Score 24.7±9.9, and head Abbreviated Injury Scale score 3.73±0.97. Acute hospital length of stay (LOS) was 12.3±8.9 days and rehabilitation LOS was 15.9±9.3 days. Day-of-injury TBI lesion volumes were inversely associated with cognitive FIM scores at rehabilitation admission (p=0.004) and discharge (p=0.004) and inversely associated with ability to be discharged to home after rehabilitation (p=0.006). Conclusion In a cohort of patients with moderate to severe TBI requiring a rehabilitation unit stay after the acute care hospital stay, DOI brain injury lesion volumes are associated with worse cognitive FIM scores at the time of rehabilitation admission and discharge. Smaller injury volumes were associated with eventual discharge to home. Volumetric neuroimaging in the acute injury phase may improve surgeons’ ultimate outcome predictions in TBI patients. Level of Evidence/Study Type Level V, case series, Prognostic/Epidemiological

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“…All admission head computerized tomography (CT) scans were classified by two authors (R.R, R.K). [1718]…”

Section: Methodsmentioning

confidence: 99%

“…The included covariates were age, the Glasgow Coma Scale (GCS) motor score, pupillary light reactivity, hypoxia, hypotension, hemoglobin, glucose, and the Helsinki CT score. [1518] The results from the logistic regression model are presented as odds ratios (OR) with 95% confidence intervals (CI).…”

Section: Methodsmentioning

confidence: 99%

Primary decompressive craniectomy is associated with worse neurological outcome in patients with traumatic brain injury requiring acute surgery

et al. 2017

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Background:The role of decompressive craniectomy in treating raised intracranial pressure (ICP) after traumatic brain injuries (TBI) is controversial. The aim of this study was to assess the differences in prognosis of patients initially treated by decompressive craniectomy, craniotomy, or conservatively.Methods:We conducted a single-center retrospective study on adult blunt TBI patients admitted to a neurosurgical intensive care unit during 2009–2012. Patients were divided into three groups based on their initial treatment – decompressive craniectomy, craniotomy, and conservative. Primary outcome was 6-month Glasgow Outcome Scale (GOS) dichotomized to favorable outcome (independent) and unfavorable outcome (dependent). The association between initial treatment and outcome was assessed using a logistic regression model adjusting for case-mix using known predictors of outcome.Results:Of the 822 included patients, 58 patients were in the craniectomy group, 401 patients in the craniotomy group, and 363 patients in the conservatively treated group. Overall, 6-month unfavorable outcome was 48%. After adjusting for case-mix, patients in the decompressive craniectomy group had a statistical significantly higher risk for poor neurological outcome compared to patients in the conservative group (OR 3.06, 95% CI 1.45–6.42) and craniotomy group (OR 3.61, 95% CI 1.74–7.51).Conclusion:In conclusion, patients requiring primary decompressive craniectomy had a higher risk for poor neurological outcome compared to patients undergoing craniotomy or were conservatively treated. It is plausible that the poor prognosis is related to the TBI severity itself rather than the intervention. Further prospective randomized trials are required to establish the role of decompressive craniectomy in the treatment of patients with TBI.

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Predicting Outcome in Traumatic Brain Injury

Abstract: Use of the novel Helsinki CT score improved outcome prediction accuracy, and the Helsinki CT score is a feasible alternative to the Rotterdam and Marshall CT systems. External validation of the Helsinki CT score is advocated to show generalizability.

Cited by 132 publications

References 47 publications

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

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

Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury

Primary decompressive craniectomy is associated with worse neurological outcome in patients with traumatic brain injury requiring acute surgery

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