An Tingting, Dong Zibei, Li Xiangyang, Ma Yifan, Jin Jie, Li Liqing, Xu Lanjuan
Department of Critical Care Medicine, Zhengzhou Central Hospital affiliated to Zhengzhou University, Zhengzhou, Henan, 450001, China.
Transl Neurosci. 2024 Mar 22;15(1):20220327. doi: 10.1515/tnsci-2022-0327. eCollection 2024 Jan 1.
Both the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) and the Corticosteroid randomization after significant head injury (CRASH) models are globally acknowledged prognostic algorithms for assessing traumatic brain injury (TBI) outcomes. The aim of this study is to externalize the validation process and juxtapose the prognostic accuracy of the CRASH and IMPACT models in moderate-to-severe TBI patients in the Chinese population.
We conducted a retrospective study encompassing a cohort of 340 adult TBI patients (aged > 18 years), presenting with Glasgow Coma Scale (GCS) scores ranging from 3 to 12. The data were accrued over 2 years (2020-2022). The primary endpoints were 14-day mortality rates and 6-month Glasgow Outcome Scale (GOS) scores. Analytical metrics, including the area under the receiver operating characteristic curve for discrimination and the Brier score for predictive precision were employed to quantitatively evaluate the model performance.
Mortality rates at the 14-day and 6-month intervals, as well as the 6-month unfavorable GOS outcomes, were established to be 22.06, 40.29, and 65.59%, respectively. The IMPACT models had area under the curves (AUCs) of 0.873, 0.912, and 0.927 for the 6-month unfavorable GOS outcomes, with respective Brier scores of 0.14, 0.12, and 0.11. On the other hand, the AUCs associated with the six-month mortality were 0.883, 0.909, and 0.912, and the corresponding Brier scores were 0.15, 0.14, and 0.13, respectively. The CRASH models exhibited AUCs of 0.862 and 0.878 for the 6-month adverse outcomes, with uniform Brier scores of 0.18. The 14-day mortality rates had AUCs of 0.867 and 0.87, and corresponding Brier scores of 0.21 and 0.22, respectively.
Both the CRASH and IMPACT algorithms offer reliable prognostic estimations for patients suffering from craniocerebral injuries. However, compared to the CRASH model, the IMPACT model has superior predictive accuracy, albeit at the cost of increased computational intricacy.
国际临床试验预后与分析任务组（IMPACT）模型和重型颅脑损伤后皮质类固醇随机对照试验（CRASH）模型都是全球公认的用于评估创伤性脑损伤（TBI）预后的预测算法。本研究的目的是将验证过程外部化，并比较CRASH模型和IMPACT模型在中国人群中中重度TBI患者的预后准确性。
我们进行了一项回顾性研究，纳入了340例成年TBI患者（年龄>18岁），其格拉斯哥昏迷量表（GCS）评分在3至12分之间。数据收集历时2年（2020 - 2022年）。主要终点为14天死亡率和6个月格拉斯哥预后量表（GOS）评分。采用分析指标，包括用于区分的受试者操作特征曲线下面积和用于预测精度的Brier评分，对模型性能进行定量评估。
14天和6个月时的死亡率以及6个月时不良GOS结局的发生率分别为22.06%、40.29%和65.59%。IMPACT模型对于6个月不良GOS结局的曲线下面积（AUC）分别为0.873、0.912和0.927，相应的Brier评分分别为0.14、0.12和0.11。另一方面，与6个月死亡率相关的AUC分别为0.883、0.909和0.912，相应的Brier评分分别为0.15、0.14和0.13。CRASH模型对于6个月不良结局的AUC分别为0.862和0.878，Brier评分为统一的0.18。14天死亡率的AUC分别为0.867和0.87，相应的Brier评分分别为0.21和0.22。
CRASH模型和IMPACT算法都能为颅脑损伤患者提供可靠的预后估计。然而，与CRASH模型相比，IMPACT模型具有更高的预测准确性，尽管代价是计算复杂度增加。
