Comparison of two prehospital predictive models for mortality and impaired consciousness after severe traumatic brain injury

Pannatier, Michel; Delhumeau, Cécile; Walder, Bernhard

doi:10.1111/aas.13229

Cited by 2 publications

(1 citation statement)

References 40 publications

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“…In the prehospital setting, an alternative score to the GCS can be the National Advisory Committee for Aeronautics severity score (NACA-SS) for the prediction of early mortality. In a Swiss prospective cohort of 677 patients with severe TBI, the NACA based model (including pupil reaction on scene, age), and a score based on M-GCS (including subscale motor score of GCS, pupil reaction on scene and age) were found to be equally accurate for the prediction of 14-day mortality [15].…”

Section: Acute Traumatic Brain Injurymentioning

confidence: 99%

Prehospital and Emergency Care in Adult Patients with Acute Traumatic Brain Injury

2019

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Traumatic brain injury (TBI) is a major healthcare problem and a major burden to society. The identification of a TBI can be challenging in the prehospital setting, particularly in elderly patients with unobserved falls. Errors in triage on scene cannot be ruled out based on limited clinical diagnostics. Potential new mobile diagnostics may decrease these errors. Prehospital care includes decision-making in clinical pathways, means of transport, and the degree of prehospital treatment. Emergency care at hospital admission includes the definitive diagnosis of TBI with, or without extracranial lesions, and triage to the appropriate receiving structure for definitive care. Early risk factors for an unfavorable outcome includes the severity of TBI, pupil reaction and age. These three variables are core variables, included in most predictive models for TBI, to predict short-term mortality. Additional early risk factors of mortality after severe TBI are hypotension and hypothermia. The extent and duration of these two risk factors may be decreased with optimal prehospital and emergency care. Potential new avenues of treatment are the early use of drugs with the capacity to decrease bleeding, and brain edema after TBI. There are still many uncertainties in prehospital and emergency care for TBI patients related to the complexity of TBI patterns.

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Section: Acute Traumatic Brain Injurymentioning

confidence: 99%

Prehospital and Emergency Care in Adult Patients with Acute Traumatic Brain Injury

2019

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Prognosis in Moderate and Severe Traumatic Brain Injury: A Systematic Review of Contemporary Models and Validation Studies

Dijkland

Foks

Polinder

et al. 2020

Journal of Neurotrauma

111

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Outcome prognostication in traumatic brain injury (TBI) is important, but challenging due to heterogeneity of the disease. The aim of this systematic review is to present the current state-of-the-art on prognostic models for outcome after moderate and severe TBI and evidence on their validity. We searched for studies reporting on the development, validation or extension of prognostic models for functional outcome after TBI with Glasgow Coma Scale (GCS) ≤ 12 published between 2006-2018. Studies with patients aged ≥14 years and evaluating a multivariable prognostic model based on admission characteristics were included. Model discrimination was expressed with the area under the receiver operating characteristic curve (AUC), and model calibration with calibration slope and intercept. We included 58 studies describing 67 different prognostic models, comprising the development of 42 models, 149 external validations of 31 models and 12 model extensions. The most common predictors were GCS (motor) score (n=55), age (n=54) and pupillary reactivity (n=48). Model discrimination varied substantially between studies. The International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) andCorticoid Randomisation After Significant Head injury (CRASH) models were developed on the largest cohorts (8,509 and 10,008 patients, respectively) and were most often externally validated (n=91), yielding AUCs ranging between 0.65-0.90 and 0.66-1.00, respectively. Model calibration was reported with a calibration intercept and slope for 7 models in 53 validations, and was highly variable. In conclusion, the discriminatory validity of the IMPACT and CRASH prognostic models is supported across a range of settings. The variation in calibration, reflecting heterogeneity in reliability of predictions, motivates continuous validation and updating if clinical implementation is pursued.

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Comparison of two prehospital predictive models for mortality and impaired consciousness after severe traumatic brain injury

Abstract: Prehospital prediction of mortality after TBI was good with both models, and the NACA-BM was not inferior to the GCS-RM. Prediction of IC-14 was moderate in both models.

Cited by 2 publications

References 40 publications

Prehospital and Emergency Care in Adult Patients with Acute Traumatic Brain Injury

Prehospital and Emergency Care in Adult Patients with Acute Traumatic Brain Injury

Prognosis in Moderate and Severe Traumatic Brain Injury: A Systematic Review of Contemporary Models and Validation Studies

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