Predicting outcome after traumatic brain injury: Practical prognostic models based on large cohort of international patients

P. A. Perel, Fatos Olldashi, Itan Muzha, Nikolin Filipi, Roberto Lede, Pablo Copertari, Carolina Traverso, Alejandro Copertari, Enrique Alfredo Vergara, Carolina Montenegro, Roberto Ruiz De Huidobro, Pantaleón Saladino, Karina Surt, José Cialzeta, Silvio Lazzeri, Gustavo Piñero, Fabiana Ciccioli, Walter Videtta, María Fernanda Barboza, Silvana SvampaVictor Sciuto, Gustavo Domeniconi, Marcelo Bustamante, Maximiliano Waschbusch, María Paula Gullo, Daniel Alberto Drago, Juan Carlos Arjona Linares, Luis Camputaro, Gustavo Tróccoli, Hernán Galimberti, Mandy Tallott, Christian Eybner, Walter Buchinger, Sylvia Fitzal, Guy Mazairac, Véronique Oleffe, Thierry Grollinger, Philippe Delvaux, Laurent Carlier, Veronique Braet, Jean-Marie Jacques, Danielle De Knoop, Luiz Nasi, Humberto Kukhuyn Choi, Mara Schmitt, André Gentil, Flavio Nacul, Pedro Bedoya Barrios, Chen Xinkang, Lin Shao Hua, Huang Han Tian, Cai Xiaodong, Wilson Gualteros, Alvaro Ardila Otero, Miguel Arango, Juan Ciro, Hector Jaramillo, Ignacio Gonzalez, Carolina Gomez, Arturo Arias, Marco Fonseca, Carlos Mora, Edgar Giovanni Luna Cabrera, José Luis Betancurth, Porfirio Muñoz, Jesus Alberto Quiñónez, Maria Esther Gonzalez Castillo, Orlando Lopez, Rafael Perez Yepes, Diana Leon Cuellar, Gerson Paez, Hernán Delgado Chaves, Pablo Emilio Ordoñez, Ricardo Plata, Riccardo Plata, Martha Pineda, Libardo Enrique Pulido, John Sergio Velez Jaramillo, Carlos Rebolledo, Oscar Palma, Caridad Soler, Irene Pastrana, Raul Falero, Mario Domínguez Perera, Agustín Arocha García, Raydel Oliva, Hubiel López Delgado, Aida Madrazo Carnero, Boris Leyva López, Angel Lacerda Gallardo, Amarilys Ortega Morales, Humberto Lezcano, Marcos Iraola Ferrer, Irene Zamalea Bess, Gladys Rivas Canino, Ernesto Miguel Piferrer Ruiz, Orlando Garcia Cruz, Petr Svoboda, Ilona Kantorová, Jiřĺ Ochmann, Peter Scheer, Ladislav Kozumplík, Jitka Maršová, Karel Edelmann, Ivan Chytra, Roman Bosman, Hana Andrejsová, Jan Pachl, Jan Bürger, Filip Kramar, Mario Izurieta Ulloa, Luis Gonzalez, Alberto Daccach, Antonio Ortega, Stenio Cevallos, Boris Zurita Cueva, Marcelo Ochoa, Jaime Velásquez Tapia, Jimmy Hurtado, Miguel Chung Sang Wong, Roberto Santos, Hussein Khamis, Abdul Hamid Abaza, Abdalla Fekry, Salah El Kordy, Tarek Shawky, Hesham El-Sayed, Nabil Khalil, Nader Negm, Salem Fisal, Mamdouh Alamin, Hany Shokry, Ahmed Yahia Elhusseny, Atif Radwan, Magdi Rashid, Tamar Gogichaisvili, George Ingorokva, Nikoloz Gongadze, Alexander Otarashvili, Waltraud Kleist, Mathias Kalkum, Peter Ulrich, Nii Andrews, George Nakos, Antonios Karavelis, George Archontakis, Pavlos Myrianthefs, Yadram Yadav, Sharda Yadav, R. Khatri, Arvind Baghel, Mazhar Husain, Deepak Jha, Wu Hoong Chhang, Manohar Dhandhania, Choden Fonning, S. N. Iyengar, Sanjay Gupta, R. R. Ravi, K. S. Bopiah, Ajay Herur, N. K. Venkataramana, A. Satish, K. Bhavadasan, Raymond Morris, S. Ramesh, A. Satish, Yashbir Dewan, Yashpal Singh, Rajesh Bhagchandani, Sanjana Bhagchandani, Vijaya Ushanath Sethurayar, Sojan Ipe, G. Sreekumar, Manas Panigrahi, Agasti Reddy, Varinder Khosla, Sunil Gupta, Haroon Pillay, Nisha Thomas, Krishnamurthy Sridhar, Bobby Jose, Nadakkavvkakan Kurian, Shanti Praharaj, Shibu Pillai, Ramana, Smita Gupta, Dilip Kiyawat, Kishor Maheshwari, Dilip Panikar, Jayant Chawla, Satyanarayana Shenoy, Annaswamy Raja, Yeshomati Rupayana, Suryanarayan Reddy, Nelanuthala Mohan, Shailesh Kelkar, Mukesh Johri, Nyoman Golden, Sri Maliawan, Achmad Fauzi, Umar Farouk, Esmaeel Fakharian, Amir Aramesh, Maasoumeh Eghtedari, Farhad Ahmadzadeh, Alireza Gholami, Patrick Plunkett, Catherine Redican, Geraldine Mcmahon, Maria Giuseppina Annetta, Homère Mouchaty, Eros Bruzzone, Béatrice Harding, Mahmood Qureshi, Zamzuri Idris, N. C. Jafri Abdullah, Ghazaime Ghazali, Abdul Rahman Izaini Ghani, Fadzli Cheah, Alfredo Cabrera, José Luis Mejía González, Jorge Loría-Castellanos, Suzanne Jackson, Robyn Hutchinson, Edward Komolafe, Augustine Adeolu, Morenikeji Komolafe, Olusanya Adeyemi-Doro, Femi Bankole, Bello Shehu, Victoria Danlami, Olugbenga Odebode, Kehinde Oluwadiya, Ahmed Sanni, Herb Giebel, Sushil Kumar, Rashid Jooma, Jose Edmundo Mezquita, Carlos Ortiz Ovelar, Marco Gonzales Portillo, Diana Rodriguez, Laura Balica, Bogdan Oprita, Mircea Sklerniacof, Luiza Steflea, Laura Bandut, Adam Danil, Remus Iliescu, Jean Ciurea, Abdelazeem El-Dawlatly, Sherif Alwatidy, Walid Al-Yafi, Megahid El-Dawlatly, Ranka Krunic-Protic, Vesna Janosevic, James Tan, Charles Seah, Štefan Trenkler, Matuš Humenansky, Tatiana Stajančová, Ivan Schwendt, Anton Laincz, Zeman Julius, Stano Maros, Jozef Firment, Maria Cifraničova, Beata Sániová, Karol Kalig, Soňa Medekova, Radovan Wiszt, Ivan Mačuga, Bennie Hartzenberg, Grant Du Plessis, Zelda Houlie, Narendra Nathoo, Sipho Khumalo, Ralph Tracey, Angeles Muñoz-Sánchez, N. C. Francisco Murillo-Cabezas, Juan Flores-Cordero, Dolores Rincón- Ferrari, Martin Rubi, Lopez Caler, Maite Misis Del Campo, Luisa Bordejé Laguna, Juan Manuel Nava, Miguel Arruego Minguillón, Alfonso Muñoz Lopez, Luis Ramos-Gómez, Victoria De La Torre-Prados, Romero Pellejero, Véronique Laloë, Bernhard Mandrella, Suganthan, Sunil Perera, Kanapathipillai Mahendran, Reto Stocker, Silke Ludwig, Heinz Zimmermann, Urs Denzler, Surakrant Yutthakasemsunt, Warawut Kittiwattanagul, Parnumas Piyavechvirat, Pojana Tapsai, Ajchara Namuang-Jan, Upapat Chantapimpa, Chanothai Watanachai, Pusit Subsompon, Wipurat Pussanakawatin, Pensri Khunjan, Sakchai Tangchitvittaya, Somsak Nilapong, Tanagorn Klangsang, Wibul Taechakosol, Atirat Srinat, Zouheir Jerbi, Nebiha Borsali- Falfoul, Monia Rezgui, Nahit Cakar, Hussein Ssenyonjo, Olive Kobusingye, Gabrielle Lomas, David Yates, Fiona Lecky, Anthony Bleetman, Alan Baldwin, Emma Jenkinson, Shiela Pantrini, James Stewart, Nasreen Contractor, Trudy Roberts, Jim Butler, Alan Pinto, Diane Lee, Nigel Brayley, Karly Robbshaw, Clare Dix, Sarah Graham, Sue Pye, Marcus Green, Annie Kellins, Chris Moulton, Barbara Fogg, Rowland Cottingham, Sam Funnell, Utham Shanker, Claire Summers, Louise Malek, Christopher Ashcroft, Jacky Powell, Steve Moore, Stephanie Buckley, Mandy Grocutt, Steve Chambers, Amanda Morrice, Helen Marshall, Julia Harris, Wendy Matthews, Jane Tippet, Simon Mardell, Fiona Macmillan, Anita Shaw, Pramod Luthra, Gill Dixon, Mohammed Ahmed, John Butler, Mike Young, Sue Mason, Ian Loveday, Christine Clark, Sam Taylor, Paul Wilson, Kassim Ali, Stuart Greenwood, Martin White, Rosa Perez, Sam Eljamel, Jonathan Wasserberg, Helen Shale, Colin Read, John Mccarron, Aaron Pennell, Gautam Ray, John Thurston, Emma Brown, Lawrence Jaffey, Michael Graves, Richard Bailey, Nancy Loveridge, Geraint Evans, Shirleen Hughes, Major Kafeel Ahmed, Jeremy Richardson, Claire Gallagher, Titus Odedun, Karen Lees, David Foley, Nick Payne, Alan Pennycook, Carl Griffiths, David Moore, Denise Byrne, Sunil Dasan, Ashis Banerjee, Abhishek Banerjee, Steve Mcguinness, Claude Chikhani, Nigel Zoltie, Ian Barlow, Ian Stell, William Hulse, Jacqueline Crossley, Laurence Watkins, Balu Dorani, Truong Van Viet

Research output: Contribution to journalArticle

Abstract

Objective: To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury. Design: Multivariable logistic regression to select variables that were independently associated with two patient outcomes. Two models designed: "basic" model (demographic and clinical variables only) and "CT" model (basic model plus results of computed tomography). The models were subsequently developed for high and low-middle income countries separately. Setting: Medical Research Council (MRC) CRASH Trial. Subjects: 10 008 patients with traumatic brain injury. Models externally validated in a cohort of 8509. Results: The basic model included four predictors: age, Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. The CT model also included the presence of petechial haemorrhages, obliteration of the third ventricle or basal cisterns, subarachnoid bleeding, midline shift, and non-evacuated haematoma. In the derivation sample the models showed excellent discrimination (C statistic above 0.80). The models showed good calibration graphically. The Hosmer-Lemeshow test also indicated good calibration, except for the CT model in low-middle income countries. External validation for unfavourable outcome at six months in high income countries showed that basic and CT models had good discrimination (C statistic 0.77 for both models) but poorer calibration. Conclusion: Simple prognostic models can be used to obtain valid predictions of relevant outcomes in patients with traumatic brain injury.
Original languageEnglish
Pages (from-to)425-429
Number of pages5
JournalBMJ. BRITISH MEDICAL JOURNAL
Volume336
DOIs
Publication statusPublished - 2008
Externally publishedYes

Keywords

  • brain injury

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