Dijkland Simone A, Helmrich Isabel R A Retel, Nieboer Daan, van der Jagt Mathieu, Dippel Diederik W J, Menon David K, Stocchetti Nino, Maas Andrew I R, Lingsma Hester F, Steyerberg Ewout W
Department of Public Health, Center for Medical Decision Making, Erasmus MC-University Medical Center, Rotterdam, the Netherlands.
Department of Intensive Care, Erasmus MC-University Medical Center, Rotterdam, the Netherlands.
J Neurotrauma. 2021 May 15;38(10):1377-1388. doi: 10.1089/neu.2020.7300. Epub 2020 Dec 14.
The International Mission on Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) and Corticoid Randomisation After Significant Head injury (CRASH) prognostic models predict functional outcome after moderate and severe traumatic brain injury (TBI). We aimed to assess their performance in a contemporary cohort of patients across Europe. The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) core study is a prospective, observational cohort study in patients presenting with TBI and an indication for brain computed tomography. The CENTER-TBI core cohort consists of 4509 TBI patients available for analyses from 59 centers in 18 countries across Europe and Israel. The IMPACT validation cohort included 1173 patients with GCS ≤12, age ≥14, and 6-month Glasgow Outcome Scale-Extended (GOSE) available. The CRASH validation cohort contained 1742 patients with GCS ≤14, age ≥16, and 14-day mortality or 6-month GOSE available. Performance of the three IMPACT and two CRASH model variants was assessed with discrimination (area under the receiver operating characteristic curve; AUC) and calibration (comparison of observed vs. predicted outcome rates). For IMPACT, model discrimination was good, with AUCs ranging between 0.77 and 0.85 in 1173 patients and between 0.80 and 0.88 in the broader CRASH selection ( = 1742). For CRASH, AUCs ranged between 0.82 and 0.88 in 1742 patients and between 0.66 and 0.80 in the stricter IMPACT selection ( = 1173). Calibration of the IMPACT and CRASH models was generally moderate, with calibration-in-the-large and calibration slopes ranging between -2.02 and 0.61 and between 0.48 and 1.39, respectively. The IMPACT and CRASH models adequately identify patients at high risk for mortality or unfavorable outcome, which supports their use in research settings and for benchmarking in the context of quality-of-care assessment.
国际创伤性脑损伤临床试验预后与分析任务组（IMPACT）和重度颅脑损伤后皮质类固醇随机试验（CRASH）预后模型可预测中度和重度创伤性脑损伤（TBI）后的功能结局。我们旨在评估它们在欧洲当代患者队列中的表现。欧洲创伤性脑损伤协作有效性研究（CENTER-TBI）核心研究是一项针对出现TBI且有脑部计算机断层扫描指征患者的前瞻性观察性队列研究。CENTER-TBI核心队列由来自欧洲18个国家和以色列59个中心的4509例可用于分析的TBI患者组成。IMPACT验证队列包括1173例格拉斯哥昏迷量表（GCS）≤12、年龄≥14岁且有6个月扩展格拉斯哥预后量表（GOSE）数据的患者。CRASH验证队列包含1742例GCS≤14、年龄≥16岁且有14天死亡率或6个月GOSE数据的患者。通过区分度（受试者工作特征曲线下面积；AUC）和校准（观察到的与预测的结局率比较）来评估三种IMPACT模型变体和两种CRASH模型变体的表现。对于IMPACT模型，模型区分度良好，在1173例患者中AUC范围为0.77至0.85，在更广泛的CRASH选择人群（n = 1742）中AUC范围为0.80至0.88。对于CRASH模型，在1742例患者中AUC范围为0.82至0.88；在更严格的IMPACT选择人群（n = 1173）中AUC范围为0.66至0.80。IMPACT和CRASH模型的校准一般处于中等水平，整体校准和校准斜率分别在-2.02至0.61和0.48至1.39之间。IMPACT和CRASH模型能够充分识别出死亡或预后不良的高风险患者，这支持它们在研究环境中的使用以及在医疗质量评估背景下作为基准。
