Prediction of outcome after moderate and severe traumatic brain injury: external validation of the International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) and Corticoid Randomisation After Significant Head injury (CRASH) prognostic models.

Prediction of outcome after moderate and severe traumatic brain injury: external validation of the International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) and Corticoid Randomisation After Significant Head injury (CRASH) prognostic models.

MedLine Citation:	PMID: 22511138 Owner: NLM Status: MEDLINE
Abstract/OtherAbstract:	OBJECTIVE: The International Mission on Prognosis and Analysis of Clinical Trials and Corticoid Randomisation After Significant Head injury prognostic models predict outcome after traumatic brain injury but have not been compared in large datasets. The objective of this is study is to validate externally and compare the International Mission on Prognosis and Analysis of Clinical Trials and Corticoid Randomisation after Significant Head injury prognostic models for prediction of outcome after moderate or severe traumatic brain injury. DESIGN: External validation study. PATIENTS: We considered five new datasets with a total of 9,036 patients, comprising three randomized trials and two observational series, containing prospectively collected individual traumatic brain injury patient data. MEASUREMENTS AND MAIN RESULTS: Outcomes were mortality and unfavorable outcome, based on the Glasgow Outcome Score at 6 months after injury. To assess performance, we studied the discrimination of the models (by area under the receiver operating characteristic curves), and calibration (by comparison of the mean observed to predicted outcomes and calibration slopes). The highest discrimination was found in the Trauma Audit and Research Network trauma registry (area under the receiver operating characteristic curves between 0.83 and 0.87), and the lowest discrimination in the Pharmos trial (area under the receiver operating characteristic curves between 0.65 and 0.71). Although differences in predictor effects between development and validation populations were found (calibration slopes varying between 0.58 and 1.53), the differences in discrimination were largely explained by differences in case mix in the validation studies. Calibration was good, the fraction of observed outcomes generally agreed well with the mean predicted outcome. No meaningful differences were noted in performance between the International Mission on Prognosis and Analysis of Clinical Trials and Corticoid Randomisation After Significant Head injury models. More complex models discriminated slightly better than simpler variants. CONCLUSIONS: Since both the International Mission on Prognosis and Analysis of Clinical Trials and the Corticoid Randomisation After Significant Head injury prognostic models show good generalizability to more recent data, they are valid instruments to quantify prognosis in traumatic brain injury.

Authors:	Bob Roozenbeek; Hester F Lingsma; Fiona E Lecky; Juan Lu; James Weir; Isabella Butcher; Gillian S McHugh; Gordon D Murray; Pablo Perel; Andrew I Maas; Ewout W Steyerberg; ; ;
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Publication Detail:	Type: Journal Article; Research Support, N.I.H., Extramural; Validation Studies
Journal Detail:	Title: Critical care medicine Volume: 40 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2012 May
Date Detail:	Created Date: 2012-04-18 Completed Date: 2012-06-11 Revised Date: 2013-05-20
Medline Journal Info:	Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States
Other Details:	Languages: eng Pagination: 1609-17 Citation Subset: AIM; IM
Affiliation:	Department of Public Health, Center for Medical Decision Making, Erasmus MC, Rotterdam, The Netherlands. b.roozenbeek@erasmusmc.nl
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MeSH Terms
Descriptor/Qualifier:	Apolipoproteins E / genetics Brain Injuries / diagnosis*, drug therapy, mortality, therapy Glasgow Outcome Scale Guanidines / therapeutic use Humans Hypothermia, Induced Logistic Models Models, Statistical Neuroprotective Agents / therapeutic use Prognosis ROC Curve Registries Tetrahydrocannabinol / analogs & derivatives, therapeutic use
Grant Support
ID/Acronym/Agency:	R01 NS-042691/NS/NINDS NIH HHS; R01 NS042691-01A1/NS/NINDS NIH HHS; R01 NS042691-04A1/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:	0/Apolipoproteins E; 0/Guanidines; 0/Neuroprotective Agents; 112924-45-5/HU 211; 1972-08-3/Tetrahydrocannabinol; 46475LV84I/aptiganel
Comments/Corrections
Comment In:	Crit Care Med. 2012 May;40(5):1685-6 [PMID: 22511165 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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