Use of the CRASH study prognosis calculator in patients with severe traumatic brain injury treated with an intracranial pressure-targeted therapy

Olivecrona, Magnus; Olivecrona, Zandra

doi:10.1016/j.jocn.2012.09.015

Cited by 25 publications

(10 citation statements)

References 22 publications

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“…over predict mortality and functional outcome in patients with severe TBI, while IMPACT might overestimate poor outcomes in less severely injured patients with TBI. 8,18 The 6 month survival predictions of healthcare providers (neurosurgeons and neurointensivists) tend to vary widely when compared to IMPACT. 19 In this study, predicting survival of patients following a TBI utilizing predictive models showed that clinicians and modeling algorithms complimented each other.…”

Section: Survival Predictionmentioning

confidence: 99%

Prognostication of Mortality and Long-Term Functional Outcomes Following Traumatic Brain Injury: Can We Do Better?

Bonds

Dhanda

Wade

et al. 2021

Journal of Neurotrauma

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Accurate prognostication of outcomes following traumatic brain injury (TBI) affects not only the aggressiveness of intervention and therapeutic decision-making, but also the clinicians' ability to provide reliable expectations. To investigate the relative ability of clinicians to accurately predict a patient's outcomes when compared to point of care prognostic models, we surveyed clinical providers of 86 patients with moderate-severe TBI at admission, day 3, and day 7 post-injury for a patient's predicted functional outcome at six months and mortality. The predicted mortality and functional outcomes were compared to actual occurrence of 14 day mortality and functional outcomes at six months. A prognostic score was then calculated utilizing the Corticoid Randomization After Signiﬁcant Head Injury (CRASH) and International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) models and categorized as high, intermediate, and low likelihood of mortality or poor functional outcome and compared to clinical predictions. Overall, clinicians of varying backgrounds showed an accurate prediction of survival (87.2-97.4%) but struggled in prognosticating poor functional outcomes (24.3-36.6%). These values did not statistically improve over 7 days. Stratified CRASH (87.2%) and IMPACT (84.9%) accuracy rates were statistically better than clinical judgment alone in predicting functional outcomes (p<0.0001). Prognostic models calculated at admission showed to be potentially useful in conjunction with clinical judgment in accurately predicting both survival and six month functional outcomes.

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Section: Survival Predictionmentioning

confidence: 99%

Prognostication of Mortality and Long-Term Functional Outcomes Following Traumatic Brain Injury: Can We Do Better?

Bonds

Dhanda

Wade

et al. 2021

Journal of Neurotrauma

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“…The self-fulfilling prophecy of early withdrawal of care may be present in observational data on which predictive models are based. One small study of 47 patients formally concluded an overestimation of unfavorable outcome by the CRASH model [125]. …”

Section: Neuroprognosticationmentioning

confidence: 99%

Medical Management of the Severe Traumatic Brain Injury Patient

et al. 2017

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Severe traumatic brain injury (sTBI) is a major contributor to long term disability and a leading cause of death worldwide. Medical management of the sTBI patient, beginning with pre-hospital triage, is aimed at preventing secondary brain injury. This review discusses prehospital and emergency department management of severe TBI, as well as aspects of TBI management in the intensive care unit where advances have been made in the past decade. Areas of emphasis include intracranial pressure management, neuromonitoring, management of paroxysmal sympathetic hyperactivity, neuroprotective strategies, prognostication, and communication with families about goals of care. Where appropriate, differences between the third and fourth editions of the Brain Trauma Foundation Guidelines for the Management of Severe Traumatic Brain Injury are highlighted.

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“…Similar to the IMPACT prognosis calculator, multiple studies found that the CRASH prognosis calculator overestimates the risk of unfavorable outcomes. These studies show that the calculator is only accurate for a risk level above 75 % for an unfavorable outcome; otherwise, the accuracy of the calculator is questionable [37][38][39][40]. As such, some studies do not recommend using the CRASH calculator for individual treatment decisions.…”

Section: Prognostic Modelsmentioning

confidence: 99%

End Points of Traumatic Brain Injury Resuscitation

Wesson

Ferrada

2015

Curr Trauma Rep

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Severe traumatic brain injury (TBI) is an insult severe enough to cause an acute and persistent loss of consciousness with a significant risk of death or disability. Worldwide, it is a leading cause of death, especially for younger people less than 50 years of age. Over the last two decades, we have made significant progress in our understanding of the pathophysiology of TBI. This however has not resulted in substantial improvements in outcome, as the incidence of TBI continues to increase and mortality rates remain relatively unchanged. To better understand the long-term outcome and end points in TBI resuscitation, tools to predict a patient's prognosis becomes essential. In this review, we discuss the role of clinical assessment, as such the Glasgow Coma Scale and the Full Outline of UnResponsiveness Score, neuroimaging, including computed tomography (CT) and MRI, and current research innovations, such as the biomarkers, to predict TBI outcomes. Additionally, we describe the clinical implications of using prognostic models, such as the International Mission on Prognosis and Analysis of Clinical Trials in TBI (IMPACT) database models and the Corticosteroid Randomization after Significant Head Injury (CRASH) trial data models to calculate TBI outcome.

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Use of the CRASH study prognosis calculator in patients with severe traumatic brain injury treated with an intracranial pressure-targeted therapy

Cited by 25 publications

References 22 publications

Prognostication of Mortality and Long-Term Functional Outcomes Following Traumatic Brain Injury: Can We Do Better?

Prognostication of Mortality and Long-Term Functional Outcomes Following Traumatic Brain Injury: Can We Do Better?

Medical Management of the Severe Traumatic Brain Injury Patient

End Points of Traumatic Brain Injury Resuscitation

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