Rached Mohamed A K B, Gaudet John G, Delhumeau Cecile, Walder Bernhard
Division of Anaesthesiology, University Hospitals of Geneva (HUG), Switzerland.
Division of Anaesthesiology, University Hospitals of Geneva (HUG), Switzerland.
Injury. 2019 Jan;50(1):65-72. doi: 10.1016/j.injury.2018.08.022. Epub 2018 Sep 3.
The subscale motor score of Glasgow Coma Scale (msGCS) and the Abbreviated Injury Score of head region (HAIS) are validated prognostic factors in traumatic brain injury (TBI). The aim was to compare the prognostic performance of a HAIS-based prediction model including HAIS, pupil reactivity and age, and the reference prediction model including msGCS in emergency department (ED), pupil reactivity and age.
Secondary analysis of a prospective epidemiological study including patients after severe TBI (HAIS > 3) with follow-up from the time of accident until 14 days or earlier death was performed in Switzerland. Performance of prediction, based on accuracy of discrimination [area under the receiver-operating curve (AUROC)], calibration (Hosmer-Lemeshow test) and validity (bootstrapping with 2000 repetitions to correct) for optimism of the two prediction models were investigated. A non-inferiority approach was performed and an a priori threshold for important differences was established.
The cohort included 808 patients [median age 56 {inter-quartile range (IQR) 33-71}, median motor part of GCS in ED 1 (1-6), abnormal pupil reactivity 29.0%] with a death rate of 29.7% at 14 days. The accuracy of discrimination was similar (AUROC HAIS-based prediction model: 0.839; AUROC msGCS-based prediction model: 0.826, difference of the 2 AUROC 0.013 (-0.007 to 0.037). A similar calibration was observed (Hosmer-Lemeshow X 11.64, p = 0.168 vs. Hosmer-Lemeshow X 8.66, p = 0.372). Internal validity of HAIS-based prediction model was high (optimism corrected AUROC: 0.837).
Performance of prediction for short-term mortality after severe TBI with HAIS-based prediction model was non-inferior to reference prediction model using msGCS as predictor.
格拉斯哥昏迷量表运动亚评分（msGCS）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。目的是比较基于HAIS的预测模型（包括HAIS、瞳孔反应性和年龄）与参考预测模型（包括急诊科的msGCS、瞳孔反应性和年龄）的预后性能。
对一项前瞻性流行病学研究进行二次分析，该研究纳入了瑞士重度TBI（HAIS＞3）患者，从事故发生时开始随访直至14天或更早死亡。基于辨别准确性[受试者操作特征曲线下面积（AUROC）]、校准（Hosmer-Lemeshow检验）和有效性（进行2000次重复自抽样以校正乐观性）来研究两种预测模型的预测性能。采用非劣效性方法并建立重要差异的先验阈值。
该队列包括808例患者[中位年龄56岁{四分位间距（IQR）33 - 71}，急诊科格拉斯哥昏迷量表运动部分中位值为1（1 - 6），瞳孔反应异常占29.0%]，14天时死亡率为29.7%。辨别准确性相似（基于HAIS的预测模型AUROC：0.839；基于msGCS的预测模型AUROC：0.826，两个AUROC差值为0.013（-0.007至0.037））。观察到校准情况相似（Hosmer-Lemeshow X值为11.64，p = 0.168，对比Hosmer-Lemeshow X值为8.66，p = 0.372）。基于HAIS的预测模型内部有效性较高（校正乐观性后的AUROC：0.837）。
基于HAIS的预测模型对重度TBI后短期死亡率的预测性能不劣于以msGCS作为预测指标的参考预测模型。
