Development and internal validation of a nomogram for predicting outcomes in children with traumatic subdural hematoma

Abstract

Background: A subdural hematoma (SDH) following a traumatic brain injury (TBI) in children can lead to unexpected death or disability. The nomogram is a clinical prediction tool used by physicians to provide prognosis advice to parents for making decisions regarding treatment. In the present study, a nomogram for predicting outcomes was developed and validated. In addition, the predictors associated with outcomes in children with traumatic SDH were determined. Methods: In this retrospective study, 103 children with SDH after TBI were evaluated. According to the King's Outcome Scale for Childhood Head Injury classification, the functional outcomes were assessed at hospital discharge and categorized into favorable and unfavorable. The predictors associated with the unfavorable outcomes were analyzed using binary logistic regression. Subsequently, a two-dimensional nomogram was developed for presentation of the predictive model. Results:The predictive model with the lowest level of Akaike information criterion consisted of hypotension (odds ratio [OR], 9.4; 95% confidence interval [CI], 2.0-42.9), Glasgow coma scale scores of 3-8 (OR, 8.2; 95% CI, 1.7-38.9), fixed pupil in one eye (OR, 4.8; 95% CI, 2.6-8.8), and fixed pupils in both eyes (OR, 3.5; 95% CI, 1.6-7.1). A midline shift ≥5 mm (OR, 1.1; 95% CI, 0.62-10.73) and co-existing intraventricular hemorrhage (OR, 6.5; 95% CI, 0.003-26.1) were also included. Conclusions: SDH in pediatric TBI can lead to mortality and disability. The predictability level of the nomogram in the present study was excellent, and external validation should be conducted to confirm the performance of the clinical prediction tool.

Development of a Clinical Nomogram for Predicting Shunt-Dependent Hydrocephalus

“…27 Currently, various clinical prediction tools have been studied in medicine, such as scoring systems, nomograms, and machine learning. 27,28 Comparison among these tools is a challenge for future research and the tool has the highest predictive performance that could be implicated in clinical practice. Moreover, the tools should be easily applied to aid physician's decision marking in the real-world situation such as web application.…”

“…Other limitations must be acknowledged. 27,28 The nomogram was a two-dimensional graphic scoring system that required scores to be assigned to each variable, making it a challenging tool to use in general practice. A Web-based nomogram or mobile application should be developed and distributed to simplify the tool for the physician's practice.…”

The Prognostic Value of Immunonutritional Indexes in Pineal Region Tumor

“…However, the authors attempted to address the limitation through the creation of an operational definition, inclusion, and exclusion criteria before the assessment. 28,29 Furthermore, the present study just assessed immunonutritional indexes in the preoperative phase. In the future, a longitudinal study with a repeated-measures design should be conducted to investigate the association between immunonutritional indexes and prognosis.…”