Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients
Objective To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury.Design Multivariable logistic regression to select variables that were independently associated with two patient outcomes. Two models designed...
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| Published in | BMJ Vol. 336; no. 7641; pp. 425 - 429 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
London
British Medical Journal Publishing Group
23.02.2008
British Medical Association BMJ Publishing Group LTD BMJ Publishing Group BMJ Publishing Group Ltd |
| Edition | International edition |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Objective To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury.Design Multivariable logistic regression to select variables that were independently associated with two patient outcomes. Two models designed: “basic” model (demographic and clinical variables only) and “CT” model (basic model plus results of computed tomography). The models were subsequently developed for high and low-middle income countries separately. Setting Medical Research Council (MRC) CRASH Trial.Subjects 10 008 patients with traumatic brain injury. Models externally validated in a cohort of 8509.Results The basic model included four predictors: age, Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. The CT model also included the presence of petechial haemorrhages, obliteration of the third ventricle or basal cisterns, subarachnoid bleeding, midline shift, and non-evacuated haematoma. In the derivation sample the models showed excellent discrimination (C statistic above 0.80). The models showed good calibration graphically. The Hosmer-Lemeshow test also indicated good calibration, except for the CT model in low-middle income countries. External validation for unfavourable outcome at six months in high income countries showed that basic and CT models had good discrimination (C statistic 0.77 for both models) but poorer calibration.Conclusion Simple prognostic models can be used to obtain valid predictions of relevant outcomes in patients with traumatic brain injury. |
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| AbstractList | To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury.
Multivariable logistic regression to select variables that were independently associated with two patient outcomes. Two models designed: "basic" model (demographic and clinical variables only) and "CT" model (basic model plus results of computed tomography). The models were subsequently developed for high and low-middle income countries separately.
Medical Research Council (MRC) CRASH Trial.
10,008 patients with traumatic brain injury. Models externally validated in a cohort of 8509.
The basic model included four predictors: age, Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. The CT model also included the presence of petechial haemorrhages, obliteration of the third ventricle or basal cisterns, subarachnoid bleeding, midline shift, and non-evacuated haematoma. In the derivation sample the models showed excellent discrimination (C statistic above 0.80). The models showed good calibration graphically. The Hosmer-Lemeshow test also indicated good calibration, except for the CT model in low-middle income countries. External validation for unfavourable outcome at six months in high income countries showed that basic and CT models had good discrimination (C statistic 0.77 for both models) but poorer calibration.
Simple prognostic models can be used to obtain valid predictions of relevant outcomes in patients with traumatic brain injury. Objective: To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury. Design: Multivariable logistic regression to select variables that were independently associated with two patient outcomes. Two models designed: "basic" model (demographic and clinical variables only) and "CT" model (basic model plus results of computed tomography). The models were subsequently developed for high and low-middle income countries separately. Setting: Medical Research Council (MRC) CRASH Trial. Subjects: 10 008 patients with traumatic brain injury. Models externally validated in a cohort of 8509. Results: The basic model included four predictors: age, Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. The CT model also included the presence of petechial haemorrhages, obliteration of the third ventricle or basal cisterns, subarachnoid bleeding, midline shift, and non-evacuated haematoma. In the derivation sample the models showed excellent discrimination (C statistic above 0.80). The models showed good calibration graphically. The Hosmer-Lemeshow test also indicated good calibration, except for the CT model in low-middle income countries. External validation for unfavourable outcome at six months in high income countries showed that basic and CT models had good discrimination (C statistic 0.77 for both models) but poorer calibration. Conclusion: Simple prognostic models can be used to obtain valid predictions of relevant outcomes in patients with traumatic brain injury. Perel et al develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury. Results show that simple prognostic models can be used to obtain valid predictions of relevant outcomes in patients with traumatic brain injury. Objective To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury. Design Multivariable logistic regression to select variables that were independently associated with two patient outcomes. Two models designed: “basic” model (demographic and clinical variables only) and “CT” model (basic model plus results of computed tomography). The models were subsequently developed for high and low-middle income countries separately. Setting Medical Research Council (MRC) CRASH Trial. Subjects 10 008 patients with traumatic brain injury. Models externally validated in a cohort of 8509. Results The basic model included four predictors: age, Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. The CT model also included the presence of petechial haemorrhages, obliteration of the third ventricle or basal cisterns, subarachnoid bleeding, midline shift, and non-evacuated haematoma. In the derivation sample the models showed excellent discrimination (C statistic above 0.80). The models showed good calibration graphically. The Hosmer-Lemeshow test also indicated good calibration, except for the CT model in low-middle income countries. External validation for unfavourable outcome at six months in high income countries showed that basic and CT models had good discrimination (C statistic 0.77 for both models) but poorer calibration. Conclusion Simple prognostic models can be used to obtain valid predictions of relevant outcomes in patients with traumatic brain injury. To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury.OBJECTIVETo develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury.Multivariable logistic regression to select variables that were independently associated with two patient outcomes. Two models designed: "basic" model (demographic and clinical variables only) and "CT" model (basic model plus results of computed tomography). The models were subsequently developed for high and low-middle income countries separately.DESIGNMultivariable logistic regression to select variables that were independently associated with two patient outcomes. Two models designed: "basic" model (demographic and clinical variables only) and "CT" model (basic model plus results of computed tomography). The models were subsequently developed for high and low-middle income countries separately.Medical Research Council (MRC) CRASH Trial.SETTINGMedical Research Council (MRC) CRASH Trial.10,008 patients with traumatic brain injury. Models externally validated in a cohort of 8509.SUBJECTS10,008 patients with traumatic brain injury. Models externally validated in a cohort of 8509.The basic model included four predictors: age, Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. The CT model also included the presence of petechial haemorrhages, obliteration of the third ventricle or basal cisterns, subarachnoid bleeding, midline shift, and non-evacuated haematoma. In the derivation sample the models showed excellent discrimination (C statistic above 0.80). The models showed good calibration graphically. The Hosmer-Lemeshow test also indicated good calibration, except for the CT model in low-middle income countries. External validation for unfavourable outcome at six months in high income countries showed that basic and CT models had good discrimination (C statistic 0.77 for both models) but poorer calibration.RESULTSThe basic model included four predictors: age, Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. The CT model also included the presence of petechial haemorrhages, obliteration of the third ventricle or basal cisterns, subarachnoid bleeding, midline shift, and non-evacuated haematoma. In the derivation sample the models showed excellent discrimination (C statistic above 0.80). The models showed good calibration graphically. The Hosmer-Lemeshow test also indicated good calibration, except for the CT model in low-middle income countries. External validation for unfavourable outcome at six months in high income countries showed that basic and CT models had good discrimination (C statistic 0.77 for both models) but poorer calibration.Simple prognostic models can be used to obtain valid predictions of relevant outcomes in patients with traumatic brain injury.CONCLUSIONSimple prognostic models can be used to obtain valid predictions of relevant outcomes in patients with traumatic brain injury. Objective To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury. Design Multivariable logistic regression to select variables that were independently associated with two patient outcomes. Two models designed: "basic" model (demographic and clinical variables only) and "CT" model (basic model plus results of computed tomography). The models were subsequently developed for high and low-middle income countries separately. Setting Medical Research Council (MRC) CRASH Trial. Subjects 10â[euro][per thousand]008 patients with traumatic brain injury. Models externally validated in a cohort of 8509. Results The basic model included four predictors: age, Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. The CT model also included the presence of petechial haemorrhages, obliteration of the third ventricle or basal cisterns, subarachnoid bleeding, midline shift, and non-evacuated haematoma. In the derivation sample the models showed excellent discrimination (C statistic above 0.80). The models showed good calibration graphically. The Hosmer-Lemeshow test also indicated good calibration, except for the CT model in low-middle income countries. External validation for unfavourable outcome at six months in high income countries showed that basic and CT models had good discrimination (C statistic 0.77 for both models) but poorer calibration. Conclusion Simple prognostic models can be used to obtain valid predictions of relevant outcomes in patients with traumatic brain injury. |
| Author | Menon Harrison |
| AuthorAffiliation | London School of Hygiene and Tropical Medicine, London WC1B 3DP. Pablo.perel@lshtm.ac.uk |
| AuthorAffiliation_xml | – name: London School of Hygiene and Tropical Medicine, London WC1B 3DP. Pablo.perel@lshtm.ac.uk |
| Author_xml | – sequence: 1 givenname: Pablo surname: Perel fullname: Perel, Pablo – sequence: 2 givenname: Miguel surname: Arango fullname: Arango, Miguel – sequence: 3 givenname: Tim surname: Clayton fullname: Clayton, Tim – sequence: 4 givenname: Phil surname: Edwards fullname: Edwards, Phil – sequence: 5 givenname: Edward surname: Komolafe fullname: Komolafe, Edward – sequence: 6 givenname: Stuart surname: Poccock fullname: Poccock, Stuart – sequence: 7 givenname: Ian surname: Roberts fullname: Roberts, Ian – sequence: 8 givenname: Haleema surname: Shakur fullname: Shakur, Haleema – sequence: 9 givenname: Ewout surname: Steyerberg fullname: Steyerberg, Ewout – sequence: 10 givenname: Surakrant surname: Yutthakasemsunt fullname: Yutthakasemsunt, Surakrant |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20168326$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/18270239$$D View this record in MEDLINE/PubMed |
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| CODEN | BMJOAE |
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| Snippet | Objective To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain... Objective To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury.... Objective: To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury.... To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury.... Perel et al develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury.... OBJECTIVE: To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury.... To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury.OBJECTIVETo... Objective To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury.... |
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| SubjectTerms | Accidents, Traffic - statistics & numerical data Adult and adolescent clinical studies Age Biological and medical sciences Brain damage Brain Injuries - diagnostic imaging Brain Injuries - mortality Calibration Clinical outcomes Clinical trials Cohort Studies Computed tomography Computerized axial tomography Database models Death & dying Disabilities General aspects Glasgow Coma Scale Head injuries Health outcomes Hematoma Hemorrhage High income Humans Income Injuries of the nervous system and the skull. Diseases due to physical agents Low income Low income groups Medical prognosis Medical research Medical sciences Modeling Mortality Multivariate Analysis Organic mental disorders. Neuropsychology Outcome Assessment (Health Care) - standards Patients Physical trauma Prognosis Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Regression analysis Tomography Tomography, X-Ray Computed Traffic Traumas. Diseases due to physical agents Traumatic brain injury Variables Ventricles (cerebral) |
| Title | Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients |
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