多中心验证急性民用穿透性脑损伤（SPIN）评分的生存率。
Multicenter Validation of the Survival After Acute Civilian Penetrating Brain Injuries (SPIN) Score.
机构信息
Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts.
Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
出版信息
Neurosurgery. 2019 Nov 1;85(5):E872-E879. doi: 10.1093/neuros/nyz127.
BACKGROUND
Civilian penetrating traumatic brain injury (pTBI) is a serious public health problem in the United States, but predictors of outcome remain largely understudied. We previously developed the Survival After Acute Civilian Penetrating Brain Injuries (SPIN) score, a logistic, regression-based risk stratification scale for estimating in-hospital and 6-mo survival after civilian pTBI with excellent discrimination (area under the receiver operating curve [AUC-ROC = 0.96]) and calibration, but it has not been validated.
OBJECTIVE
To validate the SPIN score in a multicenter cohort.
METHODS
We identified pTBI patients from 3 United States level-1 trauma centers. The SPIN score variables (motor Glasgow Coma Scale [mGCS], sex, admission pupillary reactivity, self-inflicted pTBI, transfer status, injury severity score, and admission international normalized ratio [INR]) were retrospectively collected from local trauma registries and chart review. Using the original SPIN score multivariable logistic regression model, AUC-ROC analysis and Hosmer-Lemeshow goodness of fit testing were performed to determine discrimination and calibration.
RESULTS
Of 362 pTBI patients available for analysis, 105 patients were lacking INR, leaving 257 patients for the full SPIN model validation. Discrimination (AUC-ROC = 0.88) and calibration (Hosmer-Lemeshow goodness of fit, P value = .58) were excellent. In a post hoc sensitivity analysis, we removed INR from the SPIN model to include all 362 patients (SPINNo-INR), still resulting in very good discrimination (AUC-ROC = 0.82), but reduced calibration (Hosmer-Lemeshow goodness of fit, P value = .04).
CONCLUSION
This multicenter pTBI study confirmed that the full SPIN score predicts survival after civilian pTBI with excellent discrimination and calibration. Admission INR significantly adds to the prediction model discrimination and should be routinely measured in pTBI patients.
背景
民用穿透性脑外伤（pTBI）在美国是一个严重的公共卫生问题，但结果的预测因素在很大程度上仍未得到充分研究。我们之前开发了生存急性民用穿透性脑损伤（SPIN）评分，这是一种基于逻辑的风险分层量表，用于估计民用 pTBI 患者的住院和 6 个月生存率，具有出色的区分能力（接受者操作特征曲线下的面积[AUC-ROC=0.96]）和校准，但尚未得到验证。
目的
在多中心队列中验证 SPIN 评分。
方法
我们从美国 3 个 1 级创伤中心确定了 pTBI 患者。SPIN 评分变量（运动格拉斯哥昏迷量表[mGCS]、性别、入院瞳孔反应、自我致伤性 pTBI、转移状态、损伤严重程度评分和入院国际标准化比值[INR]）从当地创伤登记处和病历回顾中回顾性收集。使用原始 SPIN 评分多变量逻辑回归模型进行 AUC-ROC 分析和 Hosmer-Lemeshow 拟合优度检验，以确定区分度和校准度。
结果
在可用于分析的 362 例 pTBI 患者中，有 105 例患者缺乏 INR，因此有 257 例患者进行了完整的 SPIN 模型验证。区分度（AUC-ROC=0.88）和校准度（Hosmer-Lemeshow 拟合优度，P 值=0.58）均非常出色。在事后敏感性分析中，我们从 SPIN 模型中删除 INR 以纳入所有 362 例患者（SPINNo-INR），仍得到非常好的区分度（AUC-ROC=0.82），但校准度降低（Hosmer-Lemeshow 拟合优度，P 值=0.04）。
结论
这项多中心 pTBI 研究证实，完整的 SPIN 评分可准确预测民用 pTBI 患者的生存率，具有出色的区分度和校准度。入院 INR 显著提高了预测模型的区分度，应在 pTBI 患者中常规测量。
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