Predicting outcomes after traumatic brain injury

Yuan, Fang; Ding, Jun; Chen, Hao; Guo, Yan; Gan, Wang; Gao, Wenwei; Chen, Shih-Wen; Huang, Tian

doi:10.1097/ta.0b013e31824b00ac

Cited by 50 publications

(26 citation statements)

References 19 publications

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“…A smooth, nonparametric calibration line created by the Lowess algorithm was used to graphically assess the models’ calibrative abilities [12]. The H-L test used the hl.ext R code written by Steyerberg [13]. In the H-L tests, p values less than 0.05 were considered statistically significant.…”

Section: Methodsmentioning

confidence: 99%

Impact of Thoracic Injury on Traumatic Brain Injury Outcome

et al. 2013

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BackgroundTo assessed the significance of thoracic injury on the 30-day mortality and outcome of traumatic brain injury (TBI).MethodsTBI patients admitted to our department were retrospectively evaluated. We developed two prognostic models based on admission predictors with logistic regression analysis to assess the significance of thoracic injuries in determining the 30-day mortality and outcome. The internal validity of the models was evaluated with the bootstrap re-sampling technique. We also validated the models in an external series of 165 patients that collected from our center. Discriminative ability was evaluated with C statistic. Calibrative ability was assessed with the Hosmer-Lemeshow test (H-L test).ResultsAmong 505 TBI patients admitted, 102 (20.2%) had thoracic injuries. Patients with a PCS ≥6 had a 3.142 and 8.065 times higher odds of mortality and poor outcome compared with patients with a PCS <6, respectively. Any one-score increase of the TTS had a 1.193 times higher odds of a poor outcome (p = 0.017). The predictive model for mortality and 30-day functional outcome both had good accuracy (AUC: 0.875; 95% confidence interval [CI], 0.841–0.910 and AUC: 0.888; 95%CI, 0.860–0.916, respectively). Internal validation showed no over optimism in any of the two models’ predictive C statistics (C statistic 0.872 for 30-day mortality and C statistic 0.884 for the 30-day neurological outcome). The external validation confirmed the discriminatory ability of these models (C statistic 0.949 (95%CI: 0.919–0.980) for 30-day mortality and C statistic 0.915 (95%CI: 0.868–0.963) for the 30-day neurological outcome). The calibration was also good for patients from the validation population (H-L test p>0.05).ConclusionThoracic injury diagnosed by CT has a negative impact on the 30-day mortality and functional outcome of TBI patients. The extent of PC and the TTS are the predictors for TBI outcome.

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Section: Methodsmentioning

confidence: 99%

Impact of Thoracic Injury on Traumatic Brain Injury Outcome

et al. 2013

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“…Notably, the performance power of the GCS scores on admission and PTH were similarly able to affect the patient's outcome (p = 0.623), and both of them were significantly better predictives than craniectomy site or postoperative PHI (p < 0.05), respectively. (Khalili et al, 2016;Yuan et al, 2012), and ICP (Khalili et al, 2016;Yuan et al, 2012). However, few studies investigated the association between postoperative complications and the long-term outcomes of DC in adult patients with TBI as we did in this study.…”

Section: Re Sultsmentioning

confidence: 84%

“…2012), GCS scores(Khalili et al, 2016;Lemcke, Ahmadi, & Meier, 2010), pupillary reactivity(Kamal et al, 2016;Yuan et al, 2012), CT findings(Khalili et al, 2016;Yuan et al, 2012), and ICP(Khalili et al, 2016;Yuan et al, 2012). However, few studies investigated the association between postoperative complications and the long-term outcomes of DC in adult patients with TBI as we did in this study.…”

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confidence: 87%

Postoperative complications influencing the long‐term outcome of head‐injured patients after decompressive craniectomy

Zhang

Liu

et al. 2018

Brain and Behavior

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ObjectivePostoperative complications are common in patients who underwent decompressive craniectomy (DC) after traumatic brain injury (TBI). However, little is known about the degree of association between the postoperative complications and the long‐term outcome of adult TBI patients after DC. The aim of this study was to evaluate the risk of postoperative complications that influenced the long‐term outcome of DC in TBI patients.MethodA total of 121 patients were studied up to 6 months after DC in TBI. The collected data included demographic, clinical and radiological information, postoperative complications, and Glasgow Outcome Scale‐Extended (GOSE) scores at follow‐up 6 months after DC. Based on their GOSE scores, they were divided into two functional groups: favorable (GOSE = 5–8) or unfavorable outcome (GOSE = 2–4) group. The characteristics of the two groups were compared using statistical analysis. Finally, a regression model was established and a receiver operating characteristic (ROC) curve was applied to analyze its performance power.ResultsOf 121 admitted patients, 31 (25.62%) sustained an unfavorable outcome. A logistic regression analysis showed that the presence of Glasgow Coma Scale (GCS) scores on admission (odds ratio [OR] 0.285, p = 0.001), posttraumatic hydrocephalus (PTH) (OR 8.688, p = 0.003), craniectomy site (OR 8.068, p = 0.033), and postoperative progressive hemorrhagic injury (PHI) (OR 6.196, p = 0.026) were independent risk factors that correlated with an unfavorable outcome. Analysis using ROC curves demonstrated that these factors had different accuracies in predicting an unfavorable outcome (AUC = 0.852 for GCS scores on admission; AUC = 0.826 for PTH, AUC = 0.617 for craniectomy site; AUC = 0.616 for postoperative PHI). The performance power of the GCS scores on admission and PTH influenced the patient's outcomes to a similar degree (p = 0.623), and either predicted the outcome better than the craniectomy site or the postoperative PHI (p < 0.05, respectively).ConclusionThese findings suggest that the occurrence of PTH and postoperative PHI were independently associated with an unfavorable long‐term outcome after DC in patients with TBI. Early prevention and treatment of PTH and postoperative PHI may be beneficial to improve the long‐term outcome, especially in patients with lower admission GCS scores or bilateral DC.

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“…Predictors we used in this study, including age, gender, coagulation status and components of circulating blood sample, can be readily obtained on admission, and their prognostic value had previously been con rmed either in tSCI or TBI patients. [4,[15][16][17] The counts of WBCs and its components, including neutrophils ratio, lymphocytes ratio and NLR, are readily available lab tests with standardized results, although rarely studied, it is reasonable to include these results into this prognostic model. Favorable prognostic value of circulating NLR at admission had been reported in ICH and TBI patients.…”

Section: Discussionmentioning

confidence: 99%

“…[2,3] Studies have identi ed several widely used standard prognostic factors at admission such as international normalized ratio (INR), activated partial thromboplastin time (APTT), platelet counts (PLT), age, Charleson Co-morbidity Index (CCI), American spinal injury association Impairment Scale (AIS) grades, and the initial Glasgow Coma Scale (GCS) score, to be associated with the outcome of tSCI patients. [4,5] Several predictive models have been built based on these factors, however, their prognostic values were limited. Thus, to develop a model with higher prognostic value is justi ed.…”

Section: Introductionmentioning

confidence: 99%

Circulating Neutrophil-to-Lymphocyte Ratio at Admission Predicts the Long-Term Outcome in Acute Traumatic Cervical Spinal Cord Injury Patients

Zhao

Lai

et al. 2020

Preprint

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Background: The prognostic value of Neutrophil-to-Lymphocyte Ratio (NLR) for the outcome of acute cervical traumatic spinal cord injury (tSCI) patients has rarely been studied by now throughout the world. Methods: We performed a single-center retrospective cohort study to evaluate the prognostic value of NLR from peripheral whole blood count in patients with acute cervical tSCI. Patients within 6 hours of acute cervical tSCI treated between Dec 2008 and May 2018 in Huashan Hospital of Fudan University were enrolled. Outcomes of patients with tSCI were assessed using American spinal injury association Impairment Scale (AIS). 6-month outcomes were dichotomized into poor outcome group (AIS A to C) and good outcome group (AIS D and E). Uni- and multivariate analyses were performed to assess the independent predictors of 6-month outcome. Two prediction models based on admission characteristics were built to evaluate the prognostic value of NLR. The discriminative ability of predictive models was evaluated using the area under the curve (AUC).Results: A total of 377 patients were identified from our single center in China PR. Multivariate analysis showed that age, AIS grade at admission, NLR (p<0.001) and coagulopathy (p = 0.003) were independent predictors of the 6-months outcome for acute cervical tSCI patients. The model combing NLR and standard variables (AUC=0.944; 95% CI, 0.923-0.964) showed a more favorable prognostic value than that without NLR (AUC=0.841; 95% CI, 0.798-0.885) in terms of 6-month outcome.Conclusions: NLR is firstly identified as an independent predictor of the 6-month outcome in acute cervical tSCI patients worldwide. The prognostic value of NLR is favorable, and a high NLR is associated with poor outcome in patients with acute cervical tSCI.

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Predicting outcomes after traumatic brain injury

Abstract: Our validated prognostic models have good performance and are generalizable to be used to predict outcome of new patients. We recommend the use of prognostic models to complement clinical decision making.

Cited by 50 publications

References 19 publications

Impact of Thoracic Injury on Traumatic Brain Injury Outcome

Impact of Thoracic Injury on Traumatic Brain Injury Outcome

Postoperative complications influencing the long‐term outcome of head‐injured patients after decompressive craniectomy

Circulating Neutrophil-to-Lymphocyte Ratio at Admission Predicts the Long-Term Outcome in Acute Traumatic Cervical Spinal Cord Injury Patients

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