Predicting 14-Day Mortality after Severe Traumatic Brain Injury: Application of the IMPACT Models in the Brain Trauma Foundation TBI-trac^® New York State Database

Abstract

Prognostic models for outcome prediction in patients with traumatic brain injury (TBI) are important instruments in both clinical practice and research. To remain current a continuous process of model validation is necessary. We aimed to investigate the performance of the International Mission on Prognosis and Analysis of Clinical Trials in TBI (IMPACT) prognostic models in predicting mortality in a contemporary New York State TBI registry developed and maintained by the Brain Trauma Foundation. The Brain Trauma Foundation (BTF) TBI-trac Ò database contains data on 3125 patients who sustained severe TBI (Glasgow Coma Scale [GCS] score £ 8) in New York State between 2000 and 2009. The outcome measure was 14-day mortality. To predict 14-day mortality with admission data, we adapted the IMPACT Core and Extended models. Performance of the models was assessed by determining calibration (agreement between observed and predicted outcomes), and discrimination (separation of those patients who die from those who survive). Calibration was explored graphically with calibration plots. Discrimination was expressed by the area under the receiver operating characteristic (ROC) curve (AUC). A total of 2513 out of 3125 patients in the BTF database met the inclusion criteria. The 14-day mortality rate was 23%. The models showed excellent calibration. Mean predicted probabilities were 20% for the Core model and 24% for the Extended model. Both models showed good discrimination with AUCs of 0.79 (Core) and 0.83 (Extended). We conclude that the IMPACT models validly predict 14-day mortality in the BTF database, confirming generalizability of these models for outcome prediction in TBI patients.

External Validation of the CRASH and IMPACT Prognostic Models in Severe Traumatic Brain Injury

“…Overall, both the CRASH and IMPACT models performed well in this external validation exercise, consistent with previous validation studies. [13][14][15][16] Comparing the data sets, there were more patients in the NNI cohort who had major extracranial injury than in the CRASH population, and more patients in the NNI cohort with one or no reactive pupil compared with the CRASH population. This was an expected finding, as the database only included severe TBI with GCS £ 8.…”

Transcranial low-level laser therapy enhances learning, memory, and neuroprogenitor cells after traumatic brain injury in mice

“…1 In the US, each year 1.4 million people sustain TBIs, 235,000 patients are hospitalized and 50,000 die. 2 Furthermore, mild-TBI has recently attracted increasing attention due to its rising incidence after concussions in contact sports, 3 and after blast injury in military conflicts.…”

Predicting Long-Term Outcome After Traumatic Brain Injury Using Repeated Measurements of Glasgow Coma Scale and Data Mining Methods

“…Traumatic brain injury (TBI), one of the major causes of death and long-lasting disability worldwide, is a disease with heterogeneous mechanisms of injury, pathology, severity, and outcome [1][2][3][4]. After acquiring TBI, patients face uncertainty of long-term outcomes regarding behavioral, cognitive, physical and social impairments that could dramatically change their life and productivity [5,6].…”