Research Reports - Prognostication of mortality and long term functional outcomes following traumatic brain injury: Can we do better?

J Neurotrauma. 2015 Jul 31

Bonds BW(1), Dhanda A(2), Wade C(3), Massetti J(4), Diaz C(5), Stein DM(6)

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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