Iba Jiro, Tasaki Osamu, Hirao Tomohito, Mohri Tomoyoshi, Yoshiya Kazuhisa, Hayakawa Koichi, Shiozaki Tadahiko, Hamasaki Toshimitsu, Nakamori Yasushi, Fujimi Satoshi, Ogura Hiroshi, Kuwagata Yasuyuki, Shimazu Takeshi
Emergency and Critical Care Medical Center Osaka Police Hospital Osaka Japan.
Department of Emergency Medicine, Unit of Clinical Medicine Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan.
Acute Med Surg. 2013 Oct 29;1(1):31-36. doi: 10.1002/ams2.5. eCollection 2014 Jan.
Treatment of severe traumatic brain injury is aided by better prediction of outcomes. The purpose of the present study was to develop and validate a prediction model using retrospective analysis of prospectively collected clinical data from two tertiary critical care medical centers in Japan.
Data were collected from 253 patients with a Glasgow Coma Scale score of <9. Within 24 h of their admission, 15 factors possibly related to outcome were evaluated. The dataset was randomly split into training and validation datasets using the repeated random subsampling method. A logistic regression model was fitted to the training dataset and predictive accuracy was assessed using the validation data.
The best model included the variables age, pupillary light reflex, extensive subarachnoid hemorrhage, intracranial pressure, and midline shift. The estimated area under the curve for the model development data was 0.957, with a 95% confidence interval of 0.926-0.987, and that for validation data was 0.947, with a 95% confidence interval of 0.909-0.980.
Our predictive model was shown to have high predictive value. It will be useful for review of treatment, family counseling, and efficient allocation of resources for patients with severe traumatic brain injury.
更好地预测结果有助于严重创伤性脑损伤的治疗。本研究的目的是通过对日本两家三级重症监护医疗中心前瞻性收集的临床数据进行回顾性分析，开发并验证一种预测模型。
收集了253例格拉斯哥昏迷量表评分<9的患者的数据。在他们入院后24小时内，评估了15个可能与预后相关的因素。使用重复随机子抽样方法将数据集随机分为训练数据集和验证数据集。将逻辑回归模型应用于训练数据集，并使用验证数据评估预测准确性。
最佳模型包括年龄、瞳孔光反射、广泛蛛网膜下腔出血、颅内压和中线移位等变量。模型开发数据的估计曲线下面积为0.957，95%置信区间为0.926 - 0.987，验证数据的估计曲线下面积为0.947，95%置信区间为0.909 - 0.980。
我们的预测模型显示具有较高的预测价值。它将有助于对严重创伤性脑损伤患者进行治疗评估、为家属提供咨询以及有效分配资源。
