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Clinical Trial
. 2015 Jan 15;32(2):83-94.
doi: 10.1089/neu.2014.3384. Epub 2014 Nov 25.

Outcome prediction after mild and complicated mild traumatic brain injury: external validation of existing models and identification of new predictors using the TRACK-TBI pilot study

Hester F Lingsma  1 , John K Yue, Andrew I R Maas, Ewout W Steyerberg, Geoffrey T Manley; TRACK-TBI Investigators
Collaborators, Affiliations
Clinical Trial

Outcome prediction after mild and complicated mild traumatic brain injury: external validation of existing models and identification of new predictors using the TRACK-TBI pilot study

Hester F Lingsma et al. J Neurotrauma. .

Abstract

Although the majority of patients with mild traumatic brain injury (mTBI) recover completely, some still suffer from disabling ailments at 3 or 6 months. We validated existing prognostic models for mTBI and explored predictors of poor outcome after mTBI. We selected patients with mTBI from TRACK-TBI Pilot, an unselected observational cohort of TBI patients from three centers in the United States. We validated two prognostic models for the Glasgow Outcome Scale Extended (GOS-E) at 6 months after injury. One model was based on the CRASH study data and another from Nijmegen, The Netherlands. Possible predictors of 3- and 6-month GOS-E were analyzed with univariate and multi-variable proportional odds regression models. Of the 386 of 485 patients included in the study (median age, 44 years; interquartile range, 27-58), 75% (n=290) presented with a Glasgow Coma Score (GCS) of 15. In this mTBI population, both previously developed models had a poor performance (area under the receiver operating characteristic curve, 0.49-0.56). In multivariable analyses, the strongest predictors of lower 3- and 6-month GOS-E were older age, pre-existing psychiatric conditions, and lower education. Injury caused by assault, extracranial injuries, and lower GCS were also predictive of lower GOS-E. Existing models for mTBI performed unsatisfactorily. Our study shows that, for mTBI, different predictors are relevant as for moderate and severe TBI. These include age, pre-existing psychiatric conditions, and lower education. Development of a valid prediction model for mTBI patients requires further research efforts.

Trial registration: ClinicalTrials.gov NCT01565551.

Keywords: GOS-E; TBI; prognostic models; validation.

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Figures

<b>FIG. 1.</b>
FIG. 1.
Calibration plot Jacobs combined model. x-axis shows predicted probabilities by the model in quintiles of patients (triangles with horizontal lines as 95% confidence intervals); y-axis shows observed probabilities. Dotted diagonal represents perfect predictions. Spikes along the x-axis are numbers of patients with favorable and unfavorable observed outcomes. ROC, receiver operating characteristic.
<b>FIG. 2.</b>
FIG. 2.
Calibration plot CRASH computed tomography model. x-axis shows predicted probabilities by the model in quintiles of patients (triangles with horizontal lines as 95% confidence intervals); y-axis shows observed probabilities. Dotted diagonal represents perfect predictions. Spikes along the x-axis are numbers of patients with favorable and unfavorable observed outcomes. ROC, receiver operating characteristic.
<b>FIG. 3.</b>
FIG. 3.
Calibration plot CRASH computed tomography model (original population). x-axis shows predicted probabilities by the model in quintiles of patients (triangles with horizontal lines as 95% confidence intervals); y-axis shows observed probabilities. Dotted diagonal represents perfect predictions. Spikes along the x-axis are numbers of patients with favorable and unfavorable observed outcomes. ROC, receiver operating characteristic.
See this image and copyright information in PMC

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