Greil Madeline E, Abdelmaksoud Omar, Agoubi Lauren L, Velonjara Julia, Wang Jin, Petroni Gustavo, Lujan Silvia, Guadagnoli Nahuel, Bell Michael J, Vavilala Monica S, Bonow Robert H
Department of Neurological Surgery, Harborview Medical Center, Seattle, Washington, USA.
Department of Surgery, School of Medicine, University of Washington, Seattle, Washington, USA.
Neurotrauma Rep. 2025 Feb 19;6(1):171-182. doi: 10.1089/neur.2024.0157. eCollection 2025.
Prognostication in severe traumatic brain injury (sTBI) is important, but few models are pediatric-specific and from low- and middle-income countries where head computed tomography (CT) scans may not be routinely available. We assessed intensive care unit admission risk factors for early mortality and unfavorable outcome in a secondary analysis of 115 children (mean 7.0 years, standard deviation [sd] 5.3) receiving sTBI (Glasgow Coma Scale [GCS] total score ≤8 or GCS motor ≤5) care in South America who participated in the 16 hospital Pediatric Guideline Adherence and Outcomes (PEGASUS) Argentina trial between September 1, 2019, and July 13, 2020. Outcomes were 14-day mortality and 3-month Glasgow Outcome Scale-Extended for Pediatrics (GOS-E Peds). First, we examined univariate associations of predictors with the two outcomes. Then, two PEGASUS logistic regression models (core model with only clinical variables and full model with both clinical and CT variables) for each of the outcomes were derived. Models were examined for fit and compared for prediction. The locally derived PEGASUS model shows a good core prediction of 14-day (area under the receiver operating characteristic curve [AUROC]: 0.92; confidence interval [CI]: 0.85-0.99) and 3-month (AUROC 0.82 CI 0.73-0.91) outcomes; findings are similar to the International Mission on Prognosis and Analysis of Randomized Controlled Trials in TBI (IMPACT), Corticosteroid Randomization after Significant Head Injury (CRASH), and Petroni models. There was no difference between core and full models in prognosticating 14-day mortality, but IMPACT ( = 0.01) and PEGASUS ( = 0.01) full models outperformed their respective core models for 3-month GOS-E Peds. Core models, including PEGASUS, can be used but full models are preferred to prognosticate outcomes after pediatric sTBI in South America. PEGASUS model validation against external datasets is needed.
在重度创伤性脑损伤（sTBI）中，预后评估很重要，但针对儿童的模型很少，且来自低收入和中等收入国家，这些国家可能无法常规进行头部计算机断层扫描（CT）。在一项二次分析中，我们评估了115名儿童（平均7.0岁，标准差[sd]5.3）在南美洲接受sTBI（格拉斯哥昏迷量表[GCS]总分≤8或GCS运动评分≤5）治疗时入住重症监护病房的早期死亡和不良预后的危险因素，这些儿童参与了2019年9月1日至2020年7月13日期间在阿根廷进行的16家医院的儿科指南依从性与结局（PEGASUS）试验。结局指标为14天死亡率和3个月儿科扩展格拉斯哥结局量表（GOS-E Peds）。首先，我们研究了预测因素与这两个结局的单变量关联。然后，针对每个结局推导了两个PEGASUS逻辑回归模型（仅包含临床变量的核心模型和同时包含临床和CT变量的完整模型）。对模型进行拟合检验并比较预测效果。本地推导的PEGASUS模型对14天（受试者工作特征曲线下面积[AUROC]：0.92；置信区间[CI]：0.85 - 0.99）和3个月（AUROC 0.82，CI 0.73 - 0.91）结局显示出良好的核心预测能力；研究结果与创伤性脑损伤随机对照试验预后与分析国际任务组（IMPACT）、重度颅脑损伤后皮质类固醇随机试验（CRASH）和佩特罗尼模型相似。在预测14天死亡率方面，核心模型和完整模型没有差异，但在3个月GOS-E Peds方面，IMPACT（P = 0.01）和PEGASUS（P = 0.01）完整模型优于各自的核心模型。可以使用包括PEGASUS在内的核心模型，但在南美洲预测儿科sTBI后的结局时，完整模型更受青睐。需要针对外部数据集对PEGASUS模型进行验证。
