Citation

Corrigan JD, Kreider S, Cuthbert J, Whyte J, Dams-O'connor K, Faul MD, Harrison-Felix CL, Whiteneck G, Pretz CR. J. Neurotrauma 2014; 31(11): 1000-1007.

Affiliation

Ohio State University, Physical Medicine & Rehabilitation, 480 Medical Center Drive, Columbus, Ohio, United States, 43210, (614) 293-3830, (614) 293-4870 ; corrigan.1@osu.edu.

Copyright

(Copyright © 2014, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2013.3145

PMID

24521197

Abstract

This study sought to determine whether there are underlying dimensions common among traumatic brain injury (TBI) severity indices and, if so, the extent to which they are interchangeable when predicting short-term outcomes. The National Trauma Data Bank (NTDB) from 2007 to 2010 provided 77,470 unweighted adult cases with ICD-9-CM TBI codes that met inclusion criteria. The severity indices studied were the Emergency Department Glasgow Coma Scale (GCS) total score and each of the subscales; worst Abbreviated Injury Scale (AIS) severity score for the head; and the worst Barell Index type. Prediction models were computed for acute care length of stay (days), intensive care unit length of stay (days), hospital discharge status (alive or dead) and, if alive, discharge disposition (home versus institutional). Multiple Correspondence Analysis (MCA) indicated a two-dimensional relationship among items from the severity indices. The primary dimension reflected overall injury severity. The secondary dimension seemed to capture volitional behavior without the capability for cogent responding. Together, the dimensions defined 2 vectors around which most of the items clustered. A scale that took advantage of the order of items along these vectors proved to be the most consistent index for predicting short-term health outcomes. MCA provided useful insight into the relationships among components of traditional TBI severity indices. The two-vector pattern may reflect the differential impact of injury on cortical and subcortical networks. Results are discussed in terms of score substitution and the ability to impute missing values.

Language: en