1 University of Manchester , Manchester Academic Health Science Centre, the Trauma Audit and Research Network (TARN), Salford Royal NHS Foundation Trust, Salford, United Kingdom .
J Neurotrauma. 2013 Dec 15;30(24):2021-30. doi: 10.1089/neu.2013.2988. Epub 2013 Nov 8.
Currently available prognostic models in Traumatic Brain Injury (TBI) are derived from historical data sets or from heterogeneous data sets, depending upon the trauma care delivered. The objective of our study was to develop models to predict survival in a recent cohort of TBI patients within a relatively homogeneous trauma care system. Records of patients with brain injury were extracted from the Trauma Audit and Research Network (TARN) database. The relationship of the variables (i.e., age, Glasgow Coma Score [GCS], pupillary reactivity, Injury Severity Score [ISS], Computed Tomography [CT] classifications, classification of various intracranial pathologies, systolic and mean blood pressure, oxygen saturation, and the presence of extracranial injury) to survival at discharge were determined. Stepwise logistical regression analysis was performed to determine the best prognostic model. Two models were derived from data of 802 patients (models A and B). Age, GCS, pupillary reactivity, hypoxia, and brainstem injury are significant predictors in both. However, model A contains ISS in contrast to model B, which contains the presence of brain swelling and major extracranial injury instead. Both models have good predictive performance (model A: area under the Receiver Operating Characteristic [ROC] curve [AUC]=0.92 [95% CI, 0.90-0.95], Nagelkerke R(2), 0.62; model B: AUC=0.93 [95% CI: 0.91-0.95], Nagelkerke R(2): 0.63). Hence, two accurate and reliable prognostic models were developed from a recent cohort of the TBI population.
目前，创伤性脑损伤（TBI）的预后模型源自历史数据集或异质数据集，具体取决于所提供的创伤护理。我们的研究目的是在相对同质的创伤护理系统中，为最近的 TBI 患者队列开发预测生存率的模型。从创伤审核和研究网络（TARN）数据库中提取脑损伤患者的记录。确定变量（即年龄、格拉斯哥昏迷评分[GCS]、瞳孔反应、损伤严重程度评分[ISS]、计算机断层扫描[CT]分类、各种颅内病变分类、收缩压和平均血压、氧饱和度和颅外损伤的存在）与出院时生存率的关系。进行逐步逻辑回归分析以确定最佳预后模型。从 802 名患者的数据中得出了两个模型（模型 A 和 B）。年龄、GCS、瞳孔反应、缺氧和脑干损伤是两者的重要预测因素。然而，模型 A 包含 ISS，而模型 B 包含脑肿胀和主要颅外损伤的存在。这两个模型都具有良好的预测性能（模型 A：ROC 曲线下面积[AUC]=0.92[95%置信区间：0.90-0.95]，Nagelkerke R(2)：0.62；模型 B：AUC=0.93[95%置信区间：0.91-0.95]，Nagelkerke R(2)：0.63）。因此，从最近的 TBI 人群中开发了两个准确可靠的预后模型。
