Research Reports - Outcome prediction after mild and complicated mild traumatic brain injury

J Neurotrauma. 2015 Jan 15;32(2):83-94

Lingsma HF(1), Yue JK, Maas AI, Steyerberg EW, Manley GT, Cooper SR,
Dams-O'Connor K, Gordon WA, Menon DK, Mukherjee P, Okonkwo DO, Puccio AM, Schnyer
DM, Valadka AB, Vassar MJ, Yuh EL

Although the majority of patients with mild traumatic brain injury (mTBI) recover
completely, some still suffer from disabling ailments at 3 or 6 months. We
validated existing prognostic models for mTBI and explored predictors of poor
outcome after mTBI. We selected patients with mTBI from TRACK-TBI Pilot, an
unselected observational cohort of TBI patients from three centers in the United
States. We validated two prognostic models for the Glasgow Outcome Scale Extended
(GOS-E) at 6 months after injury. One model was based on the CRASH study data and
another from Nijmegen, The Netherlands. Possible predictors of 3- and 6-month
GOS-E were analyzed with univariate and multi-variable proportional odds
regression models. Of the 386 of 485 patients included in the study (median age,
44 years; interquartile range, 27-58), 75% (n=290) presented with a Glasgow Coma
Score (GCS) of 15. In this mTBI population, both previously developed models had
a poor performance (area under the receiver operating characteristic curve,
0.49-0.56). In multivariable analyses, the strongest predictors of lower 3- and
6-month GOS-E were older age, pre-existing psychiatric conditions, and lower
education. Injury caused by assault, extracranial injuries, and lower GCS were
also predictive of lower GOS-E. Existing models for mTBI performed
unsatisfactorily. Our study shows that, for mTBI, different predictors are
relevant as for moderate and severe TBI. These include age, pre-existing
psychiatric conditions, and lower education. Development of a valid prediction
model for mTBI patients requires further research efforts.

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