Severe head injuries: an outcome prediction and survival analysis

Combes, P.; Fauvage, B.; Colonna, Marc; Passagia, J. G.; Chirossel, J. P.; Jacquot, C.

doi:10.1007/s001340050269

Cited by 11 publications

(17 citation statements)

References 22 publications

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“…13 The involvement of hemorrhagic causes in early death and traumatic brain injury in late death of trauma victims has been reported in another study that used survival analysis. 7 It can be concluded that death determining variables of trauma victims differ throughout time and, as a result, time elapsed after trauma must be considered in the clinical investigation. Even though the approach of injury impact per body parts is relevant, analysis of their cumulative effect using the ISS scale may be more indicated for victim characterization.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] However, to statistically verify the association between prehospital interventions and survival has been a diffi cult task for researchers worldwide, creating controversies over this resource's usefulness. 9,14 Instead of the fatality analysis, which examines the "alive or dead" dichotomy, survival analysis has been supported by researchers all over the world 6,7,10,13 to assess the prehospital care phase. Survival analysis considers survival time as a dependent variable and analyzes factors that may interfere with this result as independent variables.…”

Section: Introductionmentioning

confidence: 99%

“…Survival analysis considers survival time as a dependent variable and analyzes factors that may interfere with this result as independent variables. 6,7,13,16 No studies on trauma, where survival analysis was used to assess variables related to the prehospital period, were found in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Sobrevivência após acidentes de trânsito: impacto das variáveis clínicas e pré-hospitalares

Malvestio

Sousa

2008

Rev. Saúde Pública

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OBJECTIVE:To assess clinical and prehospital variables associated with survival of motor vehicle crash victims. METHODS:Study carried out in the city of São Paulo (Southeastern Brazil), from 1999 to 2003. Data from 175 patients, who were aged between 12 and 65 years and had been motor vehicle crash victims, were analyzed. KaplanMeier Survival Analysis was used to approach the results at the accident scene with victims scoring <11, according to the Revised Trauma Score. Variables analyzed were: sex, age, injury mechanisms, basic and advanced support procedures, Revised Trauma Score parameters and fl uctuations, time elapsed in the prehospital phase and trauma severity according to the Injury Severity Score and Maximum Abbreviated Injury Scale. RESULTS:Analysis revealed that victims who were less likely to survive during the hospitalization period showed serious lesions in the abdomen, thorax, or lower limbs, with negative fl uctuation of respiratory frequency and Revised Trauma Score in the prehospital phase. In addition, they needed specialized interventions or thoracic compressions. Brain lesions were associated with late death. CONCLUSIONS:Recognition of variables involved in the survival of motor vehicle crash victims may help to determine protocols and to make decisions in order to perform pre-and in-hospital interventions and, consequently, maximize survival.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sobrevivência após acidentes de trânsito: impacto das variáveis clínicas e pré-hospitalares

Malvestio

Sousa

2008

Rev. Saúde Pública

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“…2,10,16,36,37,39,42 Few studies have analyzed the characteristics of patients who succumbed to early death after a TBI. 2,[6][7][8] The first aim of this study was to derive a prognostic model for early death (within 48 hours) to be used within the first 6 hours after a severe TBI and to externally validate this model. The second aim was to develop a clinical prediction rule based on the previous model to identify those patients who would be most likely to die early.…”

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confidence: 99%

Validation of a prognostic score for early mortality in severe head injury cases

Gómez¹,

De-la-Cruz

Lora

et al. 2014

JNS

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Object Traumatic brain injury (TBI) represents a large health and economic burden. Because of the inability of previous randomized controlled trials (RCTs) on TBI to demonstrate the expected benefit of reducing unfavorable outcomes, the IMPACT (International Mission on Prognosis and Analysis of Clinical Trials in TBI) and CRASH (Corticosteroid Randomisation After Significant Head Injury) studies provided new methods for performing prognostic studies of TBI. This study aimed to develop and externally validate a prognostic model for early death (within 48 hours). The secondary aim was to identify patients who were more likely to succumb to an early death to limit their inclusion in RCTs and to improve the efficiency of RCTs. Methods The derivation cohort was recruited at 1 center, Hospital 12 de Octubre, Madrid (1990–2003, 925 patients). The validation cohort was recruited in 2004–2006 from 7 study centers (374 patients). The eligible patients had suffered closed severe TBIs. The study outcome was early death (within 48 hours post-TBI). The predictors were selected using logistic regression modeling with bootstrapping techniques, and a penalized reduction was used. A risk score was developed based on the regression coefficients of the variables included in the final model. Results In the validation set, the final model showed a predictive ability of 50% (Nagelkerke R2), with an area under the receiver operating characteristic curve of 89% and an acceptable calibration (goodness-of-fit test, p = 0.32). The final model included 7 variables, and it was used to develop a risk score with a range from 0 to 20 points. Age provided 0, 1, 2, or 3 points depending on the age group; motor score provided 0 points, 2 (untestable), or 3 (no response); pupillary reactivity, 0, 2 (1 pupil reacted), or 6 (no pupil reacted); shock, 0 (no) or 2 (yes); subarachnoid hemorrhage, 0 or 1 (severe deposit); cisternal status, 0 or 3 (compressed/absent); and epidural hematoma, 0 (yes) or 2 (no). Based on the risk of early death estimated with the model, 4 risk of early death groups were established: low risk, sum score 0–3 (< 1% predicted mortality); moderate risk, sum score 4–8 (predicted mortality between 1% and 10%); high risk, sum score 9–12 (probability of early death between 10% and 50%); and very high risk, sum score 13–20 (early mortality probability > 50%). This score could be used for selecting patients for clinical studies. For example, if patients with very high risk scores were excluded from our study sample, the patients included (eligibility score < 13) would represent 80% of the original sample and only 23% of the patients who died early. Conclusions The combination of Glasgow Coma Scale score, CT scanning results, and secondary insult data into a prognostic score improved the prediction of early death and the classification of TBI patients.

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“…The following patients were excluded from the consecutive series: patients admitted to the NIC unit ≥ 5 days after trauma (n = 2) or treated successfully at the NIC unit < 24 h (n = 1); patients with both pupils wide and nonreacting on arrival at the NIC unit (n = 17) and patients with one wide and nonreacting pupil and GCS 3 on arrival (n = 1), patients with gunshot injuries (n = 1); and patients lost to follow-up (n = 2). Patients with wide and nonreacting pupils were excluded because they have a strongly predicted fatal clinical course [22,23] and it could not be assessed retrospectively if active treatment had been initiated or when active treatment was stopped, which made secondary insult registration unreliable. In those patients, the clinical course is also predominantly determined by the primary injury [24].…”

Section: Patients and Characterizationmentioning

confidence: 99%

Prevention of Secondary Insults in Neurointensive Care of Traumatic Brain Injury

Elf

Nilsson²,

Enblad³

2003

European Journal of Trauma

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Background: Secondary insults/complications have a major impact on the prognosis after traumatic brain injury (TBI). The aim was to study the occurrence and prognostic value of secondary insults occurring in TBI patients, during standardized neurointensive care (NIC) dedicated to avoiding secondary insults. Material and Methods: 154 patients, 17-79 years, with acute head trauma and pathologic CT, treated during a 2-year period at the NIC unit were studied. The occurrence of defined secondary insults (standard and severe) was recorded during the 1st week of NIC from bedside surveillance charts containing one value per hour and parameter (intracranial pressure, cerebral perfusion pressure, systolic blood pressure, PaO 2 , temperature, and blood glucose). The data set was analyzed using univariate and multivariate logistic regression with favorable outcome as the response variable. Both admission variables (Glasgow Coma Scale Motor Score [GCS M], CT class, Injury Severity Score [ISS], age, and gender) and secondary insult variables were included as explanatory variables. Results: In total, 1,570 insults were identified (320 severe). In the univariate analysis, the sum of all insults, blood glucose, GCS M, CT class, and ISS showed significant effects on outcome (p < 0.05). In the multiple regression analysis, GCS M was the only significant explanatory variable. Conclusions: The occurrence of secondary insults in the NIC unit was not negligible, despite the fact that major efforts were made to avoid them. The sum score of all insult categories and high blood glucose had a statistically significant effect on favorable outcome in the univariate analysis, but secondary insults did not add any prognostic information to the neurologic grade in the multivariate analysis. This finding indicates that the insults that occurred were related to the degree of primary injury/neurologic grade.

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Severe head injuries: an outcome prediction and survival analysis

Abstract: Clinicians can determine the odds of a good outcome from the combination of three easily measurable factors using a simple diagram constructed from logistic regression. Survival analysis showed that motor score adjusted values greater than 3 had the same prognosis.

Cited by 11 publications

References 22 publications

Sobrevivência após acidentes de trânsito: impacto das variáveis clínicas e pré-hospitalares

Sobrevivência após acidentes de trânsito: impacto das variáveis clínicas e pré-hospitalares

Validation of a prognostic score for early mortality in severe head injury cases

Prevention of Secondary Insults in Neurointensive Care of Traumatic Brain Injury

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