Kesmarky Klara, Delhumeau Cecile, Zenobi Marie, Walder Bernhard
Department of Anesthesiology, Intensive Care and Clinical Pharmacology, University Hospitals of Geneva , Geneva, Switzerland .
J Neurotrauma. 2017 Jul 15;34(14):2235-2242. doi: 10.1089/neu.2016.4606. Epub 2017 Apr 26.
The Glasgow Coma Scale (GCS) and the Abbreviated Injury Score of the head region (HAIS) are validated prognostic factors in traumatic brain injury (TBI). The aim of this study was to compare the prognostic performance of an alternative predictive model including motor GCS, pupillary reactivity, age, HAIS, and presence of multi-trauma for short-term mortality with a reference predictive model including motor GCS, pupil reaction, and age (IMPACT core model). A secondary analysis of a prospective epidemiological cohort study in Switzerland including patients after severe TBI (HAIS >3) with the outcome death at 14 days was performed. Performance of prediction, accuracy of discrimination (area under the receiver operating characteristic curve [AUROC]), calibration, and validity of the two predictive models were investigated. The cohort included 808 patients (median age, 56; interquartile range, 33-71), median GCS at hospital admission 3 (3-14), abnormal pupil reaction 29%, with a death rate of 29.7% at 14 days. The alternative predictive model had a higher accuracy of discrimination to predict death at 14 days than the reference predictive model (AUROC 0.852, 95% confidence interval [CI] 0.824-0.880 vs. AUROC 0.826, 95% CI 0.795-0.857; p < 0.0001). The alternative predictive model had an equivalent calibration, compared with the reference predictive model Hosmer-Lemeshow p values (Chi2 8.52, Hosmer-Lemeshow p = 0.345 vs. Chi2 8.66, Hosmer-Lemeshow p = 0.372). The optimism-corrected value of AUROC for the alternative predictive model was 0.845. After severe TBI, a higher performance of prediction for short-term mortality was observed with the alternative predictive model, compared with the reference predictive model.
格拉斯哥昏迷量表（GCS）和头部区域简明损伤评分（HAIS）是创伤性脑损伤（TBI）中经过验证的预后因素。本研究的目的是将一个包含运动GCS、瞳孔反应性、年龄、HAIS和多发伤情况的替代预测模型对短期死亡率的预后性能与一个包含运动GCS、瞳孔反应和年龄的参考预测模型（IMPACT核心模型）进行比较。对瑞士一项前瞻性流行病学队列研究进行了二次分析，该研究纳入了重度TBI（HAIS>3）患者，结局为14天内死亡。研究了两个预测模型的预测性能、鉴别准确性（受试者操作特征曲线下面积[AUROC]）、校准情况和有效性。该队列包括808例患者（中位年龄56岁；四分位间距33 - 71岁），入院时中位GCS为3分（3 - 14分），瞳孔反应异常者占29%，14天死亡率为29.7%。替代预测模型在预测14天死亡率方面的鉴别准确性高于参考预测模型（AUROC 0.852，95%置信区间[CI] 0.824 - 0.880，而参考预测模型AUROC为0.826，95% CI 0.795 - 0.857；p<0.0001）。与参考预测模型的Hosmer-Lemeshow p值相比，替代预测模型具有相当的校准情况（卡方值8.52，Hosmer-Lemeshow p = 0.345，而参考预测模型卡方值8.66，Hosmer-Lemeshow p = 0.372）。替代预测模型的AUROC乐观校正值为0.845。与参考预测模型相比，重度TBI后，替代预测模型对短期死亡率的预测性能更高。
