Outcome Prediction after Traumatic Brain Injury: Comparison of the Performance of Routinely Used Severity Scores and Multivariable Prognostic Models

Objectives: Prognosis of outcome after traumatic brain injury (TBI) is important in the assessment of quality of care and can help improve treatment and outcome. The aim of this study was to compare the prognostic value of relatively simple injury severity scores between each other and against a gol...

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Main Authors: Marek Majdan, Alexandra Brazinova, Martin Rusnak, Johannes Leitgeb
Format: Article
Language:English
Published: Thieme Medical and Scientific Publishers Pvt. Ltd. 2017-01-01
Series:Journal of Neurosciences in Rural Practice
Subjects:
Online Access:http://www.thieme-connect.de/DOI/DOI?10.4103/0976-3147.193543
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spelling doaj-496ea799dcd8405399efc4d111a970b22021-04-02T12:11:05ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Neurosciences in Rural Practice0976-31470976-31552017-01-01080102002910.4103/0976-3147.193543Outcome Prediction after Traumatic Brain Injury: Comparison of the Performance of Routinely Used Severity Scores and Multivariable Prognostic ModelsMarek Majdan0Alexandra Brazinova1Martin Rusnak2Johannes Leitgeb3Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, SlovakiaDepartment of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, SlovakiaDepartment of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, SlovakiaDepartment of Traumatology, Medical University of Vienna, 1090 Vienna, AustriaObjectives: Prognosis of outcome after traumatic brain injury (TBI) is important in the assessment of quality of care and can help improve treatment and outcome. The aim of this study was to compare the prognostic value of relatively simple injury severity scores between each other and against a gold standard model – the IMPACT-extended (IMP-E) multivariable prognostic model. Materials and Methods: For this study, 866 patients with moderate/severe TBI from Austria were analyzed. The prognostic performances of the Glasgow coma scale (GCS), GCS motor (GCSM) score, abbreviated injury scale for the head region, Marshall computed tomographic (CT) classification, and Rotterdam CT score were compared side-by-side and against the IMP-E score. The area under the receiver operating characteristics curve (AUC) and Nagelkerke's R 2 were used to assess the prognostic performance. Outcomes at the Intensive Care Unit, at hospital discharge, and at 6 months (mortality and unfavorable outcome) were used as end-points. Results: Comparing AUCs and R 2s of the same model across four outcomes, only little variation was apparent. A similar pattern is observed when comparing the models between each other: Variation of AUCs <±0.09 and R 2s by up to ±0.17 points suggest that all scores perform similarly in predicting outcomes at various points (AUCs: 0.65–0.77; R 2s: 0.09–0.27). All scores performed significantly worse than the IMP-E model (with AUC > 0.83 and R 2 > 0.42 for all outcomes): AUCs were worse by 0.10–0.22 (P < 0.05) and R 2s were worse by 0.22–0.39 points. Conclusions: All tested simple scores can provide reasonably valid prognosis. However, it is confirmed that well-developed multivariable prognostic models outperform these scores significantly and should be used for prognosis in patients after TBI wherever possible.http://www.thieme-connect.de/DOI/DOI?10.4103/0976-3147.193543 abbreviated injury scale glasgow coma scale outcome prognosis traumatic brain injury
collection DOAJ
language English
format Article
sources DOAJ
author Marek Majdan
Alexandra Brazinova
Martin Rusnak
Johannes Leitgeb
spellingShingle Marek Majdan
Alexandra Brazinova
Martin Rusnak
Johannes Leitgeb
Outcome Prediction after Traumatic Brain Injury: Comparison of the Performance of Routinely Used Severity Scores and Multivariable Prognostic Models
Journal of Neurosciences in Rural Practice
abbreviated injury scale
glasgow coma scale
outcome
prognosis
traumatic brain injury
author_facet Marek Majdan
Alexandra Brazinova
Martin Rusnak
Johannes Leitgeb
author_sort Marek Majdan
title Outcome Prediction after Traumatic Brain Injury: Comparison of the Performance of Routinely Used Severity Scores and Multivariable Prognostic Models
title_short Outcome Prediction after Traumatic Brain Injury: Comparison of the Performance of Routinely Used Severity Scores and Multivariable Prognostic Models
title_full Outcome Prediction after Traumatic Brain Injury: Comparison of the Performance of Routinely Used Severity Scores and Multivariable Prognostic Models
title_fullStr Outcome Prediction after Traumatic Brain Injury: Comparison of the Performance of Routinely Used Severity Scores and Multivariable Prognostic Models
title_full_unstemmed Outcome Prediction after Traumatic Brain Injury: Comparison of the Performance of Routinely Used Severity Scores and Multivariable Prognostic Models
title_sort outcome prediction after traumatic brain injury: comparison of the performance of routinely used severity scores and multivariable prognostic models
publisher Thieme Medical and Scientific Publishers Pvt. Ltd.
series Journal of Neurosciences in Rural Practice
issn 0976-3147
0976-3155
publishDate 2017-01-01
description Objectives: Prognosis of outcome after traumatic brain injury (TBI) is important in the assessment of quality of care and can help improve treatment and outcome. The aim of this study was to compare the prognostic value of relatively simple injury severity scores between each other and against a gold standard model – the IMPACT-extended (IMP-E) multivariable prognostic model. Materials and Methods: For this study, 866 patients with moderate/severe TBI from Austria were analyzed. The prognostic performances of the Glasgow coma scale (GCS), GCS motor (GCSM) score, abbreviated injury scale for the head region, Marshall computed tomographic (CT) classification, and Rotterdam CT score were compared side-by-side and against the IMP-E score. The area under the receiver operating characteristics curve (AUC) and Nagelkerke's R 2 were used to assess the prognostic performance. Outcomes at the Intensive Care Unit, at hospital discharge, and at 6 months (mortality and unfavorable outcome) were used as end-points. Results: Comparing AUCs and R 2s of the same model across four outcomes, only little variation was apparent. A similar pattern is observed when comparing the models between each other: Variation of AUCs <±0.09 and R 2s by up to ±0.17 points suggest that all scores perform similarly in predicting outcomes at various points (AUCs: 0.65–0.77; R 2s: 0.09–0.27). All scores performed significantly worse than the IMP-E model (with AUC > 0.83 and R 2 > 0.42 for all outcomes): AUCs were worse by 0.10–0.22 (P < 0.05) and R 2s were worse by 0.22–0.39 points. Conclusions: All tested simple scores can provide reasonably valid prognosis. However, it is confirmed that well-developed multivariable prognostic models outperform these scores significantly and should be used for prognosis in patients after TBI wherever possible.
topic abbreviated injury scale
glasgow coma scale
outcome
prognosis
traumatic brain injury
url http://www.thieme-connect.de/DOI/DOI?10.4103/0976-3147.193543
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AT martinrusnak outcomepredictionaftertraumaticbraininjurycomparisonoftheperformanceofroutinelyusedseverityscoresandmultivariableprognosticmodels
AT johannesleitgeb outcomepredictionaftertraumaticbraininjurycomparisonoftheperformanceofroutinelyusedseverityscoresandmultivariableprognosticmodels
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