University of Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France; INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France; CHU de Bordeaux, Pole de sante publique, Service d'information medicale, Bordeaux, France.
Institute of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark; Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Arch Phys Med Rehabil. 2014 Mar;95(3 Suppl):S95-100. doi: 10.1016/j.apmr.2013.10.026.
Prognostic studies of mild traumatic brain injury (MTBI) can serve many purposes. First, they are used to describe paths and outcomes of patients with MTBI. Second, they provide information on which characteristics are associated with the occurrence of outcomes. Third, they provide insight into the causation of poor or favorable course of the disease. Finally, they can assess how differences in the probability of outcomes can help predict the course of patients. In this article, we summarize methodologic principles used by the International Collaboration on MTBI Prognosis to appraise the prognostic literature. Differentiating prognostic factors (causally linked with outcome), prognostic markers (associated but not causally), and predictors is important to guide interventions, public health policy, and research. Ideally, prognostic studies need a clear statement of the type of question (hypothesis-generating descriptive, exploration of possible prognostic variables, confirmatory modeling of prognosis); a cohort study design with standardized follow-up of a representative population of patients with MTBI; a standardized data collection using reliable and accurate tools to capture clinically, biologically, psychologically, or socially relevant variables and outcomes; and an analysis of data based on survival methods. Interpretation of prognostic studies should consider biases related to differential inclusion of nonrepresentative samples of patients, poor measurements of outcomes, and poor control for confounders. Transferring prognostic results into clinical practice should be based on estimates of the predictive performance of models and on a demonstration that patient outcomes can be improved by the use of prediction rules.
轻度创伤性脑损伤(MTBI)的预后研究可以有多种用途。首先,它们用于描述 MTBI 患者的病程和结果。其次,它们提供了与结果发生相关的特征信息。第三,它们深入了解疾病不良或良好病程的原因。最后,它们可以评估结局概率的差异如何帮助预测患者的病程。在本文中,我们总结了国际 MTBI 预后协作组织用于评估预后文献的方法学原则。区分预后因素(与结局有因果关系)、预后标志物(相关但无因果关系)和预测因素对于指导干预、公共卫生政策和研究很重要。理想情况下,预后研究需要明确提出问题的类型(假设生成描述性、探索可能的预后变量、预后模型的验证性建模);采用队列研究设计,对 MTBI 代表性患者人群进行标准化随访;使用可靠和准确的工具进行标准化数据收集,以捕捉与临床、生物学、心理学或社会相关的变量和结局;并根据生存方法分析数据。预后研究的解释应考虑与代表性差的患者样本的差异纳入、结局测量不佳以及混杂因素控制不佳相关的偏倚。将预后结果转化为临床实践应基于对模型预测性能的估计,以及证明使用预测规则可以改善患者结局。