@article{ref1,
title="The application of IMPACT prognostic models to elderly adults with traumatic brain injury: a population-based observational cohort study",
journal="Brain injury",
year="2016",
author="Staples, John A. and Wang, Jin and Zaros, Mark C. and Jurkovich, Gregory J. and Rivara, Frederick P.",
volume="30",
number="7",
pages="899-907",
abstract="OBJECTIVE: To examine the performance of the International Mission for Prognosis and Clinical Trial Design in Traumatic Brain Injury (IMPACT) prognostic models in older patients. <br><br>METHODS: Using data from the National Study on Costs and Outcomes of Trauma (NSCOT), this study identified adult patients presenting to US hospitals in 2001 and 2002 with non-penetrating moderate or severe traumatic brain injury (GCS ≤ 12). IMPACT model calibration and discrimination in the older stratum (65-84 years) was compared to that in the younger stratum (18-64 years). <br><br>RESULTS: IMPACT model discrimination did not differ significantly between the older (n = 202; weighted n = 268) and younger strata (n = 613; weighted n = 1632) and was generally adequate (c-statistic for the core-death model = 0.81 [0.77-0.84] vs 0.75 [0.66-0.84], respectively; p = 0.26). IMPACT model calibration was poor for both older and younger strata (Hosmer-Lemeshow p-value for the core-death model = 0.01 vs < 0.0001, respectively). Pre-specified qualitative graphical evaluation suggested substantial under-prediction of mortality in the oldest decades of life, but not among younger patients. <br><br>CONCLUSIONS: The examined IMPACT prognostic models demonstrated adequate discrimination and poor calibration in both older and younger patients, yet particular caution may be required when applying these models to the elderly.<p /> <p>Language: en</p>",
language="en",
issn="0269-9052",
doi="10.3109/02699052.2016.1146964",
url="http://dx.doi.org/10.3109/02699052.2016.1146964"
}