Prediction of Prognosis in Patients of Diffuse Brain Injury Using Prognostic Predictive Model Developed by Nimhans

Abstract

BACKGROUND:The management part of patients of diffuse brain injury is always critical and is associated with the high mortality and morbidity. Many prediction model for prognosis evaluation in diffuse brain injury patients have been developed. These prediction models so far has shown no promising role in therapeutic part of management but sensitivity and specificity of such model in detecting outcome has been observed and validated. In our study we have compiled the data of 400 patients with diagnosis of diffuse brain injury and evaluated their predicted outcome based on prediction scoring developed by National Institute of Mental Health and Neurosciences (NIMHANS) in 2003 and observed the actual outcome at the end of one month of observation. MATERIAL &METHODS: The outcomes of 400 patients with severe diffuse brain injury (GCS<8) were analyzed prospectively. On admission their prediction scoring were done based on the NIMHANS prognostic predictive model .Patients with scores of less than zero were graded to have unfavourable outcome. The actual outcomes of the patients at the end of one month were observed -death or persistent vegetative state was grouped in unfavourable outcome whereas patients those who showed improvement with or without disability were said to have favourable outcome. The percentage of unfavourable outcome was measured and the sensitivity, specificity. Predictive value for favourable and unfavourable outcome of the model in our study was measured and compared to the original study of NIMHANS. RESULTS: The sensitivity, specificity, negative and positive predictive value for the model calculated were 71.68, 83.33, 53. 98 and 91.52 respectively which showed the good efficacy of the model in predicting the outcome in our patients of head injury. CONCLUSION: The prognostic model developed by NIMHANS is a good outcome prediction model which can guide towards the prognosis and further intensive care of the patient but at the same time cannot be used to guide initial therapy .Moreover inclusion of MRI findings can improve accuracy of the study as CT Scan may not show obvious changes in thin patient.