Towards Development of a Survival Prediction Tool for Pediatric Head Injury

Abstract

Background: The ability to provide an accurate prognosis for children with traumatic brain injury (TBI) would be useful for the children’s families and the caregivers. In this study we examined whether an appropriate mathematical model can predict survival in this patient population. Methods: Data from the Children’s Hospital of Eastern Ontario (CHEO) TBI registry was analyzed. First, a series of univariate logistic regressions was performed to ascertain the significance of individual predictors, such as age, maximum Glasgow Coma Scale (GCS) score, maximum head injury Abbreviated Injury Scores (AIS) and the Injury Severity Score (ISS). Second, a multinomial logistic regression was fitted using only individually significant predictors and inmodel predictor significance, and interactions were tested. Only two significant predictors were kept in the final model. This final model was subsequently used to predict survival for each individual patient using the n-1 training set (i.e. Lachenbruch’s leave-one-out method). The receiver operating characteristics (ROC) method was used to ascertain specificity-sensitivity trade-offs at different probability cut-offs in order to predict survival. Results: Only the maximum GCS and head injury AIS remained significant, both individually and in the polynomial logistic regression. Empiric ROC curve analyses from leave-one-out survival predictions showed statistical significance (area under the curve = 0.87, Z = 6.8, p < 0.001). Only 12% of cases were misclassified using the ‘best’ cut-off. Conclusion: An outcome predictive model for pediatric TBI can be devised using an appropriate mathematical model. It may help to estimate expected outcomes in pediatric TBI more objectively.

Guideline Adherence and Hospital Costs in Pediatric Severe Traumatic Brain Injury*

“…(1) Outcomes after pediatric TBI depend on factors such as age, injury severity and intent of injury,(2–4) but timely and high quality acute care is also of vital importance. (5–8) Publication of the 2003 and 2012 pediatric TBI guidelines represent important interdisciplinary efforts to provide guidance on provision of evidence-based acute care for infants and children with severe TBI.…”

Acute Care Clinical Indicators Associated With Discharge Outcomes in Children With Severe Traumatic Brain Injury*

“…1 Outcomes after pediatric TBI depend on factors such as age, injury severity and intent of injury 2-4 but may also depend on timely and high quality acute care 5-9 . Publication of the 2003 Pediatric TBI Guidelines represents the first interdisciplinary effort to provide guidance on provision of evidence-based acute care for infants and children with severe TBI 10 but the association between adherence and outcomes has not been examined.…”