轻度创伤性脑损伤后创伤后症状预测模型的开发:TRACK-TBI试点研究

Development of a Prediction Model for Post-Concussive Symptoms following Mild Traumatic Brain Injury: A TRACK-TBI Pilot Study.

作者信息

Cnossen Maryse C, Winkler Ethan A, Yue John K, Okonkwo David O, Valadka Alex B, Steyerberg Ewout W, Lingsma Hester F, Manley Geoffrey T

机构信息

Center for Medical Decision Making, Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.

Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.

出版信息

J Neurotrauma. 2017 Aug 15;34(16):2396-2409. doi: 10.1089/neu.2016.4819. Epub 2017 Jun 9.

Abstract

Post-concussive symptoms occur frequently after mild traumatic brain injury (mTBI) and may be categorized as cognitive, somatic, or emotional. We aimed to: 1) assess whether patient demographics and clinical variables predict development of each of these three symptom categories, and 2) develop a prediction model for 6-month post-concussive symptoms. Patients with mTBI (Glasgow Coma Scale score 13-15) from the prospective multi-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot study (2010-2012) who completed the Rivermead Post Concussion Symptoms Questionnaire (RPQ) at 6 months post-injury were included. Linear regression was utilized to determine the predictive value of candidate predictors for cognitive, somatic, and emotional subscales individually, as well as the overall RPQ. The final prediction model was developed using least absolute shrinkage and selection operator shrinkage and bootstrap validation. We included 277 mTBI patients (70% male; median age 42 years). No major differences in the predictive value of our set of predictors existed for the cognitive, somatic, and emotional subscales, and therefore one prediction model for the RPQ total scale was developed. Years of education, pre-injury psychiatric disorders, and prior TBI were the strongest predictors of 6-month post-concussive symptoms. The total set of predictors explained 21% of the variance, which decreased to 14% after bootstrap validation. Demographic and clinical variables at baseline are predictive of 6-month post-concussive symptoms following mTBI; however, these variables explain less than one-fifth of the total variance in outcome. Model refinement with larger datasets, more granular variables, and objective biomarkers are needed before implementation in clinical practice.

摘要

脑震荡后症状在轻度创伤性脑损伤(mTBI)后经常出现,可分为认知、躯体或情感症状。我们的目的是:1)评估患者人口统计学和临床变量是否能预测这三种症状类型中每种类型的发展,以及2)建立一个预测6个月后脑震荡后症状的模型。纳入前瞻性多中心创伤性脑损伤转化研究与临床知识(TRACK-TBI)试点研究(2010 - 2012年)中mTBI(格拉斯哥昏迷量表评分为13 - 15分)且在受伤后6个月完成Rivermead脑震荡后症状问卷(RPQ)的患者。采用线性回归分别确定候选预测因子对认知、躯体和情感子量表以及总体RPQ的预测价值。最终的预测模型是使用最小绝对收缩和选择算子收缩以及自助法验证来建立的。我们纳入了277例mTBI患者(70%为男性;中位年龄42岁)。我们这组预测因子对认知、躯体和情感子量表的预测价值没有重大差异,因此为RPQ总量表建立了一个预测模型。受教育年限、伤前精神障碍和既往TBI是6个月后脑震荡后症状的最强预测因子。预测因子的总体集合解释了21%的方差,自助法验证后降至14%。基线时的人口统计学和临床变量可预测mTBI后6个月的脑震荡后症状;然而,这些变量解释的结果总方差不到五分之一。在临床实践中实施之前,需要用更大的数据集、更精细的变量和客观生物标志物对模型进行优化。

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