Citation

Bonds BW, Dhanda A, Wade C, Massetti J, Diaz C, Stein DM. J. Neurotrauma 2015; ePub(ePub): ePub.

Affiliation

University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, United States ; dstein@umm.edu.

Copyright

(Copyright © 2015, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2014.3742

PMID

26230149

Abstract

Accurate prognostication of outcomes following traumatic brain injury (TBI) affects not only the aggressiveness of intervention and therapeutic decision-making, but also the clinicians' ability to provide reliable expectations. To investigate the relative ability of clinicians to accurately predict a patient's outcomes when compared to point of care prognostic models, we surveyed clinical providers of 86 patients with moderate-severe TBI at admission, day 3, and day 7 post-injury for a patient's predicted functional outcome at six months and mortality. The predicted mortality and functional outcomes were compared to actual occurrence of 14 day mortality and functional outcomes at six months. A prognostic score was then calculated utilizing the Corticoid Randomization After Significant Head Injury (CRASH) and International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) models and categorized as high, intermediate, and low likelihood of mortality or poor functional outcome and compared to clinical predictions. Overall, clinicians of varying backgrounds showed an accurate prediction of survival (87.2-97.4%) but struggled in prognosticating poor functional outcomes (24.3-36.6%). These values did not statistically improve over 7 days. Stratified CRASH (87.2%) and IMPACT (84.9%) accuracy rates were statistically better than clinical judgment alone in predicting functional outcomes (p<0.0001). Prognostic models calculated at admission showed to be potentially useful in conjunction with clinical judgment in accurately predicting both survival and six month functional outcomes.

Language: en