Use and limitations of prognostic models for the critically ill

Ho, Kwok M.

doi:10.1016/j.jcrc.2016.06.003

Cited by 5 publications

(2 citation statements)

References 8 publications

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“…A C C E P T E D ACCEPTED MANUSCRIPT 10 Second, our results are different from some previous reports in which the presence of DAI on the MRI scan is more important than some clinical and CT brain features in determining long-term patient outcome. 13,14 There are a few possible reasons for this difference.…”

Section: A N U S C R I P Tcontrasting

confidence: 99%

Prognostic Significance of Magnetic Resonance Imaging in Patients with Severe Nonpenetrating Traumatic Brain Injury Requiring Decompressive Craniectomy

Honeybul

Ambati

2018

World Neurosurgery

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Section: A N U S C R I P Tcontrasting

confidence: 99%

Prognostic Significance of Magnetic Resonance Imaging in Patients with Severe Nonpenetrating Traumatic Brain Injury Requiring Decompressive Craniectomy

Honeybul

Ambati

2018

World Neurosurgery

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“…[7][8][9] Although these two models have excellent ability to discriminate between patients with and without long-term unfavorable outcome (with area under the receiver-operatingcharacteristic (AUROC) curve >0.80), [7][8][9] their calibration remains far from perfect limiting their utility in medical decision-making. 10,11 One possible way to improve the accuracy of the current prognostic models is to incorporate magnetic resonance imaging (MRI) findings. It is well established that diffuse axonal injury (DAI) − caused by angular or rotational acceleration-deceleration forces to the brain − can induce severe cerebral edema as well as multiple petechial hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

089 Prognostic significance of magnetic resonance imaging in patients with severe non-penetrating traumatic brain injury requiring decompressive craniectomy

Honeybul

Ambati

2018

J Neurol Neurosurg Psychiatry

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IntroductionDiffuse axonal injury (DAI) detected on magnetic resonance imaging (MRI) may be useful to predict outcome after traumatic brain injury (TBI).MethodsThis study compared the ability of the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) prognostic model with DAI on MRI, to predict 18 months neurological outcome in 56 patients who had required a decompressive craniectomy after TBI.Of the 56 patients included in the study (19 scans occurred within 14 days; median time for all patients 24 days, interquartile range 14–42), 18 (32%) had evidence of DAI on the MRI scans. The presence of DAI on the MRI diffusion-weighted (DW), T2*-weighted-gradient echo and susceptibility-weighted (SWI) sequences was associated with an increased risk of unfavourable outcome at 18 months compared to those without DAI (44% vs. 17%, difference=27%, 95% confidence interval 2.4%–46.7%; p=0.032), particularly when brainstem was involved. However, neither the grading (I to IV) nor the number of brain regions with DAI was as good as the IMPACT model in discriminating between patients with unfavourable and favourable outcome (area under the receiver-operating-characteristic curve: 0.625 and 0.621 vs 0.918, respectively; p<0.001 for both comparisons). After adjusting for the IMPACT prognostic risks, DAI in different brain regions and the grading of DAI were also not independently associated with unfavourable outcome.ConclusionThe prognostic significance of DAI on MRI may, in part, be captured by the IMPACT prognostic model. More research is needed before MRI should be routinely used to prognosticate outcomes of patients with TBI requiring decompressive craniectomy.

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Predicting Outcome Following Traumatic Brain Injury

2021

Traumatic Brain Injury

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Use and limitations of prognostic models for the critically ill

Cited by 5 publications

References 8 publications

Prognostic Significance of Magnetic Resonance Imaging in Patients with Severe Nonpenetrating Traumatic Brain Injury Requiring Decompressive Craniectomy

Prognostic Significance of Magnetic Resonance Imaging in Patients with Severe Nonpenetrating Traumatic Brain Injury Requiring Decompressive Craniectomy

089 Prognostic significance of magnetic resonance imaging in patients with severe non-penetrating traumatic brain injury requiring decompressive craniectomy

Predicting Outcome Following Traumatic Brain Injury

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