A1 Refereed original research article in a scientific journal

Prediction of Global Functional Outcome and Post-Concussive Symptoms after Mild Traumatic Brain Injury: External Validation of Prognostic Models in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study




AuthorsMikolić Ana, Polinder Suzanne, Steyerberg Ewout W, Retel Helmrich Isabel RA, Giacino Joseph T, Maas Andrew IR, van der Naalt Joukje, Voormolen Daphne C, von Steinbüchel Nicole, Wilson Lindsay, Lingsma Hester F, van Klaveren David; the CENTER-TBI Participants and Investigators

PublisherMary Ann Liebert

Publication year2021

JournalJournal of Neurotrauma

Volume38

Issue2

First page 196

Last page209

Number of pages14

ISSN0897-7151

DOIhttps://doi.org/10.1089/neu.2020.7074

Self-archived copy’s web addresshttps://research.utu.fi/converis/portal/Publication/49616588


Abstract

The majority of traumatic brain injuries (TBIs) are categorized as mild, according to a baseline Glasgow Coma Scale (GCS) score of 13-15. Prognostic models that were developed to predict functional outcome and persistent post-concussive symptoms (PPCS) after mild TBI have rarely been externally validated. We aimed to externally validate models predicting 3-12-month Glasgow Outcome Scale Extended (GOSE) or PPCS in adults with mild TBI. We analyzed data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) project, which included 2862 adults with mild TBI, with 6-month GOSE available for 2374 and Rivermead Post-Concussion Symptoms Questionnaire (RPQ) results available for 1605 participants. Model performance was evaluated based on calibration (graphically and characterized by slope and intercept) and discrimination (C-index). We validated five published models for 6-month GOSE and three for 6-month PPCS scores. The models used different cutoffs for outcome and some included symptoms measured 2 weeks post-injury. Discriminative ability varied substantially (C-index between 0.58 and 0.79). The models developed in the Corticosteroid Randomisation After Significant Head Injury (CRASH) trial for prediction of GOSE <5 discriminated best (C-index 0.78 and 0.79), but were poorly calibrated. The best performing models for PPCS included 2-week symptoms (C-index 0.75 and 0.76). In conclusion, none of the prognostic models for early prediction of GOSE and PPCS has both good calibration and discrimination in persons with mild TBI. In future studies, prognostic models should be tailored to the population with mild TBI, predicting relevant end-points based on readily available predictors.


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Last updated on 2024-26-11 at 16:53