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Prediction of Global Functional Outcome and Post-Concussive Symptoms after Mild Traumatic Brain Injury: External Validation of Prognostic Models in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

DOI

  1. Does continuous electroencephalography influence therapeutic decisions in neurocritical care?

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  2. Differences between Men and Women in Treatment and Outcome after Traumatic Brain Injury

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  3. Frequency of fatigue and its changes in the first 6 months after traumatic brain injury: results from the CENTER-TBI study

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  • Ana Mikolić
  • Suzanne Polinder
  • Ewout W Steyerberg
  • Isabel R A Retel Helmrich
  • Joseph T Giacino
  • Andrew I R Maas
  • Joukje van der Naalt
  • Daphne C Voormolen
  • Nicole von Steinbüchel
  • Lindsay Wilson
  • Hester F Lingsma
  • David van Klaveren
  • Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study Participants and Investigators
  • Daniel Kondziella (Medlem af forfattergruppering)
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The majority of traumatic brain injuries (TBIs) are categorized as mild, according to a baseline Glasgow Coma Scale (GCS) score of 13-15. Prognostic models that were developed to predict functional outcome and persistent post-concussive symptoms (PPCS) after mild TBI have rarely been externally validated. We aimed to externally validate models predicting 3-12-month Glasgow Outcome Scale Extended (GOSE) or PPCS in adults with mild TBI. We analyzed data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) project, which included 2862 adults with mild TBI, with 6-month GOSE available for 2374 and Rivermead Post-Concussion Symptoms Questionnaire (RPQ) results available for 1605 participants. Model performance was evaluated based on calibration (graphically and characterized by slope and intercept) and discrimination (C-index). We validated five published models for 6-month GOSE and three for 6-month PPCS scores. The models used different cutoffs for outcome and some included symptoms measured 2 weeks post-injury. Discriminative ability varied substantially (C-index between 0.58 and 0.79). The models developed in the Corticosteroid Randomisation After Significant Head Injury (CRASH) trial for prediction of GOSE <5 discriminated best (C-index 0.78 and 0.79), but were poorly calibrated. The best performing models for PPCS included 2-week symptoms (C-index 0.75 and 0.76). In conclusion, none of the prognostic models for early prediction of GOSE and PPCS has both good calibration and discrimination in persons with mild TBI. In future studies, prognostic models should be tailored to the population with mild TBI, predicting relevant end-points based on readily available predictors.

OriginalsprogEngelsk
TidsskriftJournal of Neurotrauma
Vol/bind38
Udgave nummer2
Sider (fra-til)196-209
Antal sider14
ISSN0897-7151
DOI
StatusUdgivet - 15 jan. 2021

ID: 61290800