Clinical Results and Outcome Improvement Over Time in Traumatic Brain Injury

被引:4
|
作者
Di Deo, Priscilla [7 ]
Lingsma, Hester [2 ]
Nieboer, Daan [2 ]
Roozenbeek, Bob [3 ]
Citerio, Giuseppe [4 ,5 ]
Beretta, Luigi [6 ]
Magnoni, Sandra [1 ,7 ]
Zanier, Elisa R. [8 ]
Stocchetti, Nino [1 ,7 ]
机构
[1] Univ Milan, Dept Physiopathol & Transplantat, Milan, Italy
[2] Erasmus Univ, Med Ctr, Dept Publ Hlth, Rotterdam, Netherlands
[3] Erasmus Univ, Med Ctr, Dept Neurol, Rotterdam, Netherlands
[4] Univ Milano Bicocca, Sch Med & Surg, Monza, Italy
[5] San Gerardo Hosp, Neurointens Care, Monza, Italy
[6] Hosp San Raffaele, Inst Sci, Neurointens Care Unit, Milan, Italy
[7] Osped Maggiore Policlin, Fdn IRCCS Ca Granda, Dept Anesthesiol & Intens Care, Neurointens Care Unit, Milan, Italy
[8] IRCCS Ist Mario Negri, Dept Neurosci, Via G La Masa 19, I-20154 Milan, Italy
关键词
outcome; prognostic models; traumatic brain injury; GLASGOW COMA SCALE; HEAD-INJURY; EXTERNAL VALIDATION; IMPACT MODELS; INTERNATIONAL MISSION; PROGNOSTIC MODELS; MODERATE; CRASH; PREDICTION; CARE;
D O I
10.1089/neu.2015.4026
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Prognostic models for traumatic brain injury (TBI) are important tools both in clinical practice and research if properly validated, preferably by external validation. Prognostic models also offer the possibility of monitoring performance by comparing predicted outcomes with observed outcomes. In this study, we applied the prognostic models developed by the International Mission on Prognosis and Analysis of Clinical Trials in TBI (IMPACT) in an Italian multi-center database (Neurolink) with two aims: to compare observed with predicted outcomes and to check for a possible improvement of clinical outcome over the 11 years of patient inclusion in Neurolink. We applied the IMPACT models to patients included in Neurolink between 1997 and 2007. Performance of the models was assessed by determining calibration (with calibration plots) and discrimination (by the area under the receiver operating characteristic curve [AUC]). Logistic regression analysis was used to analyze a possible trend in outcomes over time, adjusted for predicted outcomes. A total of 1401 patients were studied. Patients had a median age of 40 years and 51% had a Glasgow Coma Scale motor score of 5 or 6. The models showed good discrimination, with AUCs of 0.86 (according to the Core Model) and 0.88 (Extended Model), and adequate calibration, with the overall observed risk of unfavorable outcome and mortality being less than predicted. Outcomes significantly improved over time. This study shows that the IMPACT models performed reasonably well in the Neurolink data and can be used for monitoring performance. After adjustment for predicted outcomes with the prognostic models, we observed a substantial improvement of patient outcomes over time in the three Neurolink centers.
引用
收藏
页码:2019 / 2025
页数:7
相关论文
共 50 条
  • [31] Glasgow Outcome Scale Measures and Impact on Analysis and Results of a Randomized Clinical Trial of Severe Traumatic Brain Injury
    Yamal, Jose-Miguel
    Hannay, H. Julia
    Gopinath, Shankar
    Aisiku, Imoigele P.
    Benoit, Julia S.
    Robertson, Claudia S.
    JOURNAL OF NEUROTRAUMA, 2019, 36 (17) : 2484 - 2492
  • [32] Changes in discourse structure over time following traumatic brain injury
    Lindsey, Andre
    Mozeiko, Jennifer
    Krueger, Frank
    Grafman, Jordan
    Coelho, Carl
    NEUROPSYCHOLOGIA, 2018, 119 : 308 - 319
  • [33] Metamemory adjustments over time in adults with and without traumatic brain injury
    Krause, Miriam
    Kennedy, Mary R. T.
    BRAIN INJURY, 2009, 23 (12) : 965 - 972
  • [34] Impact of Thoracic Injury on Traumatic Brain Injury Outcome
    Dai, Dawei
    Yuan, Qiang
    Sun, Yinfeng
    Yuan, Fang
    Su, Zuopeng
    Ding, Jun
    Tian, Hengli
    PLOS ONE, 2013, 8 (09):
  • [35] Brain imaging and behavioral outcome in traumatic brain injury
    Bigler, ED
    JOURNAL OF LEARNING DISABILITIES, 1996, 29 (05) : 515 - 530
  • [36] DIFFUSE TRAUMATIC BRAIN INJURY RESULTS IN BIMODAL VARIATION OF SYNAPTIC MARKER EXPRESSION IN THE SOMATOSENSORY CORTEX OVER TIME
    May, Hazel
    Ogle, Sarah
    Rowe, Rachel
    Khodadad, Aida
    Adelson, P. David
    Lifshitz, Jonathan
    Thomas, Theresa
    JOURNAL OF NEUROTRAUMA, 2015, 32 (12) : A78 - A78
  • [37] Headaches in Traumatic Brain Injury: Improvement Over Time, Associations With Quality of Life, and Impact of Migraine-Type Headaches
    Flynn, Spencer
    Moore, Brian
    van der Merwe, Andre J.
    Moses, Anita
    Lo, Jessica
    Shahim, Pashtun
    Chan, Leighton
    JOURNAL OF HEAD TRAUMA REHABILITATION, 2023, 38 (02) : E109 - E117
  • [38] Traumatic brain injury in childhood: Intensive Care time series data and outcome
    Jones, PA
    Andrews, PJD
    Easton, VJ
    Minns, RA
    BRITISH JOURNAL OF NEUROSURGERY, 2003, 17 (01) : 29 - 39
  • [39] Serum neurofilament light protein predicts clinical outcome in traumatic brain injury
    Shahim, Pashtun
    Gren, Magnus
    Liman, Victor
    Andreasson, Ulf
    Norgren, Niklas
    Tegner, Yelverton
    Mattsson, Niklas
    Andreasen, Niels
    Ost, Martin
    Zetterberg, Henrik
    Nellgard, Bengt
    Blennow, Kaj
    SCIENTIFIC REPORTS, 2016, 6
  • [40] Serum neurofilament light protein predicts clinical outcome in traumatic brain injury
    Pashtun Shahim
    Magnus Gren
    Victor Liman
    Ulf Andreasson
    Niklas Norgren
    Yelverton Tegner
    Niklas Mattsson
    Niels Andreasen
    Martin Öst
    Henrik Zetterberg
    Bengt Nellgård
    Kaj Blennow
    Scientific Reports, 6