Wan X, Zhao K, Wang S, Zhang H, Zeng L, Wang Y, Han L, Beejadhursing R, Shu K, Lei T. World Neurosurg. 2017; 103: 584-590.
Affiliation
Department of Neurosurgery, Tongji hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China. Electronic address: naowai1@tjh.tjmu.edu.cn.
BACKGROUND: Many investigators endeavor to predict the outcome based on admission characteristics using some established models to determine which management should be applied. However, the efficacy and applicability of the models using in the geriatric severe traumatic brain injury (TBI) patients have not been evaluated yet.
METHODS: 137 geriatric severe TBI patients were enrolled in this retrospective study. Receiver operating characteristics (ROC) curves were constructed to evaluate the efficacy and usability of the IMPACT prognostic model in evaluating the prognosis for these patients.
RESULTS: The observed mortality and unfavorable outcome at 6th month of severe patients were 54.7% and 70.8% respectively, slightly lower than the predicted outcome using IMPACT model. ROC curve analysis showed an area under the curve (AUC) in the Core model for mortality of 0.76 and of unfavorable outcome of 0.80, in the Extended model of 0.76 and 0.79 respectively, and in the Lab model of 0.73 and 0.77 respectively. When expected risk of fatal outcome was greater than 90% in any models, the true positive rate was 100%. Moreover, when the predicted risk >70% for unfavorable outcome in any model, the actual unfavorable outcome was over 80%.
CONCLUSIONS: The IMPACT prognosis calculator just showed fair discrimination when predicting the outcome of the elderly with severe TBI. A management decision should be made on a case-by-case basis rather than relying on the predicted risk of this model, however, conservative treatment might be preferable when expected risk of fatal outcome was >90%.