Journal of Neurosciences in Rural Practice
 
ORIGINAL ARTICLE
Year : 2017  |  Volume : 8  |  Issue : 1  |  Page : 20-29

Outcome prediction after traumatic brain injury: Comparison of the performance of routinely used severity scores and multivariable prognostic models


1 Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia; International Neurotrauma Research Organization, 1090 Vienna, Austria
2 Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
3 Department of Traumatology, Medical University of Vienna, 1090 Vienna, Austria

Correspondence Address:
Marek Majdan
Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Univerzitne Namestie 1, 91701 Trnava

Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-3147.193543

Rights and Permissions

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 R2 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 R2s 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 R2s by up to ±0.17 points suggest that all scores perform similarly in predicting outcomes at various points (AUCs: 0.65–0.77; R2s: 0.09–0.27). All scores performed significantly worse than the IMP-E model (with AUC > 0.83 and R2 > 0.42 for all outcomes): AUCs were worse by 0.10–0.22 (P < 0.05) and R2s 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.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed818    
    Printed7    
    Emailed0    
    PDF Downloaded5    
    Comments [Add]    

Recommend this journal