马德拉斯颅脑损伤预后评定量表（MHIPS）对创伤性脑损伤患者死亡率预测的诊断准确性

Diagnostic Accuracy of the Madras Head Injury Prognostication Scale (MHIPS) in Predicting Mortality among Traumatic Brain Injury Patients.

作者信息

Y Nikhil Reddy, J Devendra Prasad K, R Krishna Moorthy D G S, K Rajesh, R Aravind S

机构信息

Department of Emergency Medicine, Sri Devaraj Urs Medical College, Kolar, Karnataka, India.

出版信息

Asian J Neurosurg. 2025 Jun 2;20(3):514-522. doi: 10.1055/s-0045-1808233. eCollection 2025 Sep.

DOI:10.1055/s-0045-1808233

PMID:40852075

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12370330/

Abstract

BACKGROUND

Accurate prediction of outcomes in traumatic brain injury (TBI) is crucial for optimizing therapeutic interventions and improving patient survival rates.

OBJECTIVES

This article determines the diagnostic accuracy of Madras Head Injury Prognostication Scale (MHIPS) in predicting mortality among patients with TBI, and compares the performance of MHIPS scores with that of Corticosteroid Randomisation after Significant Head Injury (CRASH) and International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) scores.

MATERIALS AND METHODS

This was a prospective observational study conducted among patients ( = 100) with clinical evidence of TBI presenting to the Department of Emergency Medicine, R. L. Jalappa Hospital and Research Centre, Tamaka, Karnataka, India, between August 2023 and July 2024.

RESULTS

Of the 100 patients, 92 patients (92.0%) were survivors of which 4 patients (4.0%) had disability and 8 patients died/nonsurvivors (8.0%). Age more than 40 years, higher heart rate, lower Glasgow Coma Scale scores, lower MHIPS scores, higher CRASH scores, and higher IMPACT scores were significantly ( < 0.05) associated with mortality among patients with TBI. However, gender, mode of injury, diagnosis, time to presentation, systolic blood pressure (BP), diastolic BP, and respiratory rate did not vary significantly between nonsurvivors and survivors in the present study ( > 0.05). The mean (standard deviation) duration of ventilation among nonsurvivors was 3.3 (2.2), and that among survivors was 0.5 (1.1)-the difference was statistically significant ( < 0.05). The area under the curve of MHIPS scores was 0.912, in comparison with 0.893 for CRASH scores and 0.927 for IMPACT scores ( < 0.05). The MHIPS scores, with a cutoff of 13.5, showed a sensitivity of 87.5%, specificity of 81.5%, positive predictive value (PPV) of 29.2%, and negative predictive value (NPV) of 98.7%. The CRASH scores, with a cutoff of 5.5, demonstrated a sensitivity of 87.5%, specificity of 53.3%, PPV of 14.0%, and NPV of 98.0%. The IMPACT scores, with a cutoff of 8.5, had a sensitivity of 87.5%, specificity of 91.3%, PPV of 46.7%, and NPV of 98.8%. All three scoring systems showed statistically significant predictive accuracy.

CONCLUSION

MHIPS, CRASH, and IMPACT are effective tools for prognosticating mortality in TBI patients. MHIPS score offers simplicity and ease of use, making it valuable in resource-limited environments.

摘要

背景

准确预测创伤性脑损伤（TBI）的预后对于优化治疗干预措施和提高患者生存率至关重要。

目的

本文确定马德拉斯头部损伤预后量表（MHIPS）在预测TBI患者死亡率方面的诊断准确性，并将MHIPS评分的表现与重度头部损伤后皮质类固醇随机试验（CRASH）和临床试验预后与分析国际任务组（IMPACT）评分的表现进行比较。

材料与方法

这是一项前瞻性观察性研究，于2023年8月至2024年7月在印度卡纳塔克邦塔马卡的RL贾拉帕医院和研究中心急诊科对100例有TBI临床证据的患者进行。

结果

100例患者中，92例（92.0%）存活，其中4例（4.0%）有残疾，8例死亡/未存活（8.0%）。年龄超过40岁、心率较高、格拉斯哥昏迷量表评分较低、MHIPS评分较低、CRASH评分较高和IMPACT评分较高与TBI患者的死亡率显著相关（P<0.05）。然而，在本研究中，非存活者和存活者之间的性别、损伤方式、诊断、就诊时间、收缩压（BP）、舒张压和呼吸频率没有显著差异（P>0.05）。非存活者的平均（标准差）通气时间为3.3（2.2）天，存活者为0.5（1.1）天，差异具有统计学意义（P<0.05）。MHIPS评分的曲线下面积为0.912，CRASH评分为0.893，IMPACT评分为0.927（P<0.05）。MHIPS评分的临界值为13.5时，敏感性为87.5%，特异性为81.5%，阳性预测值（PPV）为29.2%，阴性预测值（NPV）为98.7%。CRASH评分的临界值为5.5时，敏感性为87.5%，特异性为53.3%，PPV为14.0%，NPV为98.0%。IMPACT评分的临界值为8.5时，敏感性为87.5%，特异性为91.3%，PPV为46.7%，NPV为98.8%。所有三种评分系统均显示出具有统计学意义的预测准确性。