Citation

Einarsen CE, van der Naalt J, Jacobs B, Follestad T, Moen KG, Vik A, Håberg AK, Skandsen T. World Neurosurg. 2018; 114: e1199-e1210.

Affiliation

Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway N-7006; Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, The Norwegian University of Science and Technology, NTNU, Trondheim, Norway N-7491.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.wneu.2018.03.176

PMID

29614364

Abstract

BACKGROUND: Patients with moderate traumatic brain injury (TBI) are often studied together with patients with severe TBI, even though expected outcome is better. Therefore, we aimed to describe patient characteristics and 12-month outcome, and to develop a prognostic model based on admission data, specifically for patients with moderate TBI.

METHODS: Patients with Glasgow Coma Scale score of 9-13 and age ≥16 years were prospectively enrolled in two level I trauma centers in Europe. Glasgow Outcome Scale Extended (GOSE) score was assessed at 12 months. A prognostic model predicting moderate disability or worse (GOSE score ≤6) as opposed to a good recovery, was fitted by penalized regression. Model performance was evaluated by area under the curve (AUC) of the receiver operating characteristics curves.

RESULTS: Of the 395 enrolled patients 81% had intracranial lesions on head CT and 71% were admitted to an intensive care unit. At 12 months, 44% were moderately disabled or worse (GOSE score ≤6), while 8% were severely disabled and 6% died (GOSE score ≤4). Higher age, lower GCS score, no day-of-injury alcohol intoxication, presence of a subdural hematoma, occurrence of hypoxia and/or hypotension and pre-injury disability were significant predictors of GOSE score ≤6 (AUC = 0.80).

CONCLUSIONS: Patients with moderate TBI exhibit characteristics of significant brain injury. Although few patients died or experienced severe disability, 44% did not experience good recovery, indicating that follow-up is needed. The model is a first step in development of prognostic models for moderate TBI that are valid across centers.

Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.

Language: en

Keywords

Cohort studies; Comparative study; Craniocerebral trauma; Prognosis; Statistical models