Citation

Kesmarky KJ, Delhumeau C, Zenobi M, Walder B. J. Neurotrauma 2017; 34(14): 2235-2242.

Affiliation

University Hospital of Geneva, Division of Anaesthesiology , Rue Gabrielle-Perret-Gentil 4 , Geneva 14, Switzerland , CH-1211 ; Bernhard.Walder@hcuge.ch.

Copyright

(Copyright © 2017, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2016.4606

PMID

28323524

Abstract

The Glasgow Coma Scale (GCS) and the abbreviated injury score of the head region (HAIS) are validated prognostic factors in traumatic brain injury (TBI). The aim of this study was to compare the prognostic performance of an alternative predictive model including motor GCS, pupillary reactivity, age, HAIS, and presence of multi-trauma for short term mortality with a reference predictive model including motor GCS, pupil reaction and age (IMPACT core model). A secondary analysis of a prospective epidemiological cohort study in Switzerland including patients after severe TBI (HAIS >3) with the outcome death at 14 days was performed. Performance of prediction, accuracy of discrimination [area under the ROC curve (AUROC)], calibration and validity of the two predictive models were investigated. The cohort included 808 patients [median age 56 {inter-quartile range (IQR) 33-71}, median GCS at hospital admission 3 (3-14), abnormal pupil reaction 29%] with a death rate of 29.7% at 14 days. The alternative predictive model had a higher accuracy of discrimination to predict death at 14 days than the reference predictive model [AUROC: 0.852 (95%CI 0.824 - 0.880) vs. 0.826 (95%CI 0.795 - 0.857); p<0.0001]. The alternative predictive model had an equivalent calibration compared with the reference predictive model, Hosmer-Lemeshow P values (Chi2 8.52, Hosmer-Lemeshow p=0.345 vs. Chi2 8.66, Hosmer-Lemeshow p=0.372). The optimism corrected value of AUROC for the alternative predictive model was 0.845. After severe TBI a higher performance of prediction for short-term mortality was observed with the alternative predictive model compared to the reference predictive model.

Language: en

Keywords

HEAD TRAUMA; OUTCOME MEASURES; Other; PROSPECTIVE STUDY