Simplifying the use of prognostic information in traumatic brain injury. Part 2: Graphical presentation of probabilities

Murray, Gordon; Brennan, Paul M.; Teasdale, Graham M.

doi:10.3171/2017.12.jns172782

Cited by 43 publications

(39 citation statements)

References 52 publications

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“…In the current study group, cognitive impairment according to BNIS was present in 54% of cases and impaired global outcome according to GOSE in 37%. Higher age and lower GCS score had an independent effect on cognitive and global outcome, while no association was observed with sex or the other injury severity variables, which agrees with the results of previous studies (26)(27)(28)(29).…”

Section: Discussionsupporting

confidence: 90%

Impact of pituitary dysfunction on cognitive and global outcome after traumatic brain injury and aneurysmal subarachnoid haemorrhage

Tölli¹,

Höybye²,

Bellander³

et al. 2019

J Rehabil Med

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Traumatic brain injury and aneurysmal subarachnoid haemorrhage are leading causes of physical, cognitive and behavioural disabilities. Traumatic brain injury and aneurysmal subarachnoid haemorrhage may affect the hypothalamus and pituitary gland, which are of major importance for our hormone balance. The purpose of the study was to investigate the relationship between the pituitary dysfunction after traumatic brain injury and aneurysmal aneurysmal subarachnoid haemorrhage, and cognitive and global outcomes at 12 months after the injury. In total, we included 127 patients during neurointensive care. Follow-up was at a rehabilitation medicine department. The study showed negative associations between high level of growth hormone and prolactin and behavioural and cognitive function; and between low gonadotropins and high prolactin and global outcome. We conclude that some pituitary dysfunctions during the first year after traumatic brain injury and aneurysmal subarachnoid haemorrhage may have clinically relevant, independent effects on clinical outcome at 12 months. Objective: To explore associations between pituitary dysfunction and clinical outcome at 12 months after traumatic brain injury and aneurysmal subarachnoid haemorrhage. Methods: Prospective cohort study of 82 patients with traumatic brain injury and 45 with aneurysmal subarachnoid haemorrhage, included at one neurointensive care unit. Baseline data comprised age, sex, Glasgow Coma Scale (GCS) score, S100B and pupil light reactions. Hormone data were collected in the neurointensive care unit and after 3, 6 and 12 months. Outcome was assessed with Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS), Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) and Glasgow Outcome Scale Extended (GOSE). Results: The most frequent hormonal deviations were hypogonadotropic hypogonadism (38%) and hypercortisolism (52%). At 12 months, performance on BNIS was impaired in 54% and GOSE in 37%. Controlling for baseline variables, low levels of gonadal hormones were associated with lower GOSE score (b =-0.80, p = 0.033), high levels of prolactin with lower RLAS (b =-1.42, p = 0.034) and high levels of serum insulin-like growth factor I (S-IGF-I) with lower RLAS level (b =-1.78, p = 0.002) and lower GOSE score (b =-1.49, p = 0.006). Conclusion: These data suggest that pituitary dysfunctions during the first year after traumatic brain injury and aneurysmal subarachnoid haemorrhage may have clinically relevant, independent effects on clinical outcome at 12 months.

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Section: Discussionsupporting

confidence: 90%

Impact of pituitary dysfunction on cognitive and global outcome after traumatic brain injury and aneurysmal subarachnoid haemorrhage

Tölli¹,

Höybye²,

Bellander³

et al. 2019

J Rehabil Med

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“…This requires the inclusion of a variable highly predictive for mortality which is already available in an early stage of disease. Considering prognostic models in TBI, level of consciousness and pupil status represent major predictive features as recently demonstrated by the GCS-P as a novel score 10,20 . This has also been modeled as ECS using pupil reactivity, size and modified motor score 11,21 .…”

Section: Discussionmentioning

confidence: 99%

Initial pupil status is a strong predictor for in-hospital mortality after aneurysmal subarachnoid hemorrhage

Mader

Piffko

Dengler

et al. 2020

Sci Rep

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Prognosis of patients with high-grade aneurysmal subarachnoid hemorrhage (aSAH) is onlyinsufficiently displayed by current standard prognostic scores. This study aims to evaluate the role of pupil status for mortality prediction and provide improved prognostic models. Anonymized data of 477 aSAH patients admitted to our medical center from November 2010 to August 2018 were retrospectively analyzed. Identification of variables independently predicting in-hospital mortality was performed by multivariable logistic regression analysis. Final regression models included Hunt & Hess scale (H&H), pupil status and age or in a simplified variation only H&H and pupil status, leading to the design of novel H&H-Pupil-Age score (HHPA) and simplified H&H-Pupil score (sHHP), respectively. In an external validation cohort of 402 patients, areas under the receiver operating characteristic curves (AUROC) of HHPA (0.841) and sHHP (0.821) were significantly higher than areas of H&H (0.794; p < 0.001) or World Federation of Neurosurgical Societies (WFNS) scale (0.775; p < 0.01). Accordingly, including information about pupil status improves the predictive performance of prognostic scores for in-hospital mortality in patients with aSAH. HHPA and sHHP allow simple, early and detailed prognosis assessment while predictive performance remained strong in an external validation cohort suggesting adequate generalizability and low interrater variability.

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“…How this assessment tool can be built upon to add other predictive features in a graphic presentation is described in our companion paper. 14…”

Section: Discussionmentioning

confidence: 99%

Simplifying the use of prognostic information in traumatic brain injury. Part 1: The GCS-Pupils score: an extended index of clinical severity

Brennan¹,

Murray

Teasdale

2018

Journal of Neurosurgery

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132

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OBJECTIVE Glasgow Coma Scale (GCS) scores and pupil responses are key indicators of the severity of traumatic brain damage. The aim of this study was to determine what information would be gained by combining these indicators into a single index and to explore the merits of different ways of achieving this. METHODS Information about early GCS scores, pupil responses, late outcomes on the Glasgow Outcome Scale, and mortality were obtained at the individual patient level by reviewing data from the CRASH (Corticosteroid Randomisation After Significant Head Injury; n = 9,045) study and the IMPACT (International Mission for Prognosis and Clinical Trials in TBI; n = 6855) database. These data were combined into a pooled data set for the main analysis. Methods of combining the Glasgow Coma Scale and pupil response data varied in complexity from using a simple arithmetic score (GCS score [range 3-15] minus the number of nonreacting pupils [0, 1, or 2]), which we call the GCS-Pupils score (GCS-P; range 1-15), to treating each factor as a separate categorical variable. The content of information about patient outcome in each of these models was evaluated using Nagelkerke's R. RESULTS Separately, the GCS score and pupil response were each related to outcome. Adding information about the pupil response to the GCS score increased the information yield. The performance of the simple GCS-P was similar to the performance of more complex methods of evaluating traumatic brain damage. The relationship between decreases in the GCS-P and deteriorating outcome was seen across the complete range of possible scores. The additional 2 lowest points offered by the GCS-Pupils scale (GCS-P 1 and 2) extended the information about injury severity from a mortality rate of 51% and an unfavorable outcome rate of 70% at GCS score 3 to a mortality rate of 74% and an unfavorable outcome rate of 90% at GCS-P 1. The paradoxical finding that GCS score 4 was associated with a worse outcome than GCS score 3 was not seen when using the GCS-P. CONCLUSIONS A simple arithmetic combination of the GCS score and pupillary response, the GCS-P, extends the information provided about patient outcome to an extent comparable to that obtained using more complex methods. The greater range of injury severities that are identified and the smoothness of the stepwise pattern of outcomes across the range of scores may be useful in evaluating individual patients and identifying patient subgroups. The GCS-P may be a useful platform onto which information about other key prognostic features can be added in a simple format likely to be useful in clinical practice.

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Simplifying the use of prognostic information in traumatic brain injury. Part 2: Graphical presentation of probabilities

Cited by 43 publications

References 52 publications

Impact of pituitary dysfunction on cognitive and global outcome after traumatic brain injury and aneurysmal subarachnoid haemorrhage

Impact of pituitary dysfunction on cognitive and global outcome after traumatic brain injury and aneurysmal subarachnoid haemorrhage

Initial pupil status is a strong predictor for in-hospital mortality after aneurysmal subarachnoid hemorrhage

Simplifying the use of prognostic information in traumatic brain injury. Part 1: The GCS-Pupils score: an extended index of clinical severity

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