Citation

Subaiya S, Roberts I, Komolafe E, Perel P. BMC Emerg. Med. 2012; 12(1): 17.

Copyright

(Copyright © 2012, Holtzbrinck Springer Nature Publishing Group - BMC)

DOI

10.1186/1471-227X-12-17

PMID

23157693

Abstract

BACKGROUND: Traumatic brain injury (TBI) affects approximately 10 million people annually, of which intracranial hemorrhage (ICH) is a devastating sequelae, occurring in one-third to half of cases. Patients in low and middle-income countries (LMIC) are twice as likely to die following TBI as compared to those in high-income countries. Diagnostic capabilities and treatment options for ICH are limited in LMIC as there are fewer computed tomography (CT) scanners and neurosurgeons per patient as in high-income countries. METHODS: The Medical Research Council CRASH-1 trial was utilized to build this model. The study cohort included all patients from LMIC who received a CT scan of the brain (n = 5669). Prognostic variables investigated included age, sex, time from injury to randomization, pupil reactivity, cause of injury, seizure and the presence of major extracranial injury. RESULTS: There were five predictors that were included in the final model; age, Glasgow Coma Scale, pupil reactivity, the presence of a major extracranial injury and time from injury to presentation. The model demonstrated good discrimination and excellent calibration (c-statistic 0.71). A simplified risk score was created for clinical settings to estimate the percentage risk of ICH among TBI patients. CONCLUSION: Simple prognostic models can be used in LMIC to estimate the risk of ICH among TBI patients. Combined with clinical judgment this may facilitate risk stratification, rapid transfer to higher levels of care and treatment in resource-poor settings.

Language: en