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Moderate Traumatic Brain Injury: Clinical Characteristics and a Prognostic Model of 12-Month Outcome.
World Neurosurg. 2018 Jun; 114:e1199-e1210.WN

Abstract

BACKGROUND

Patients with moderate traumatic brain injury (TBI) often are studied together with patients with severe TBI, even though the expected outcome of the former is better. Therefore, we aimed to describe patient characteristics and 12-month outcomes, and to develop a prognostic model based on admission data, specifically for patients with moderate TBI.

METHODS

Patients with Glasgow Coma Scale scores of 9-13 and age ≥16 years were prospectively enrolled in 2 level I trauma centers in Europe. Glasgow Outcome Scale Extended (GOSE) score was assessed at 12 months. A prognostic model predicting moderate disability or worse (GOSE score ≤6), as opposed to a good recovery, was fitted by penalized regression. Model performance was evaluated by area under the curve of the receiver operating characteristics curves.

RESULTS

Of the 395 enrolled patients, 81% had intracranial lesions on head computed tomography, and 71% were admitted to an intensive care unit. At 12 months, 44% were moderately disabled or worse (GOSE score ≤6), whereas 8% were severely disabled and 6% died (GOSE score ≤4). Older age, lower Glasgow Coma Scale score, no day-of-injury alcohol intoxication, presence of a subdural hematoma, occurrence of hypoxia and/or hypotension, and preinjury disability were significant predictors of GOSE score ≤6 (area under the curve = 0.80).

CONCLUSIONS

Patients with moderate TBI exhibit characteristics of significant brain injury. Although few patients died or experienced severe disability, 44% did not experience good recovery, indicating that follow-up is needed. The model is a first step in development of prognostic models for moderate TBI that are valid across centers.

Authors+Show Affiliations

Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, The Norwegian University of Science and Technology, NTNU, Trondheim, Norway. Electronic address: cathrine.einarsen@ntnu.no.Department of Neurology AB51, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Department of Neurology AB51, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, The Norwegian University of Science and Technology, NTNU, Trondheim, Norway.Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, The Norwegian University of Science and Technology, NTNU, Trondheim, Norway; Department of Radiology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, The Norwegian University of Science and Technology, NTNU, Trondheim, Norway.Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, The Norwegian University of Science and Technology, NTNU, Trondheim, Norway.Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, The Norwegian University of Science and Technology, NTNU, Trondheim, Norway.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

29614364

Citation

Einarsen, Cathrine Elisabeth, et al. "Moderate Traumatic Brain Injury: Clinical Characteristics and a Prognostic Model of 12-Month Outcome." World Neurosurgery, vol. 114, 2018, pp. e1199-e1210.
Einarsen CE, van der Naalt J, Jacobs B, et al. Moderate Traumatic Brain Injury: Clinical Characteristics and a Prognostic Model of 12-Month Outcome. World Neurosurg. 2018;114:e1199-e1210.
Einarsen, C. E., van der Naalt, J., Jacobs, B., Follestad, T., Moen, K. G., Vik, A., Håberg, A. K., & Skandsen, T. (2018). Moderate Traumatic Brain Injury: Clinical Characteristics and a Prognostic Model of 12-Month Outcome. World Neurosurgery, 114, e1199-e1210. https://doi.org/10.1016/j.wneu.2018.03.176
Einarsen CE, et al. Moderate Traumatic Brain Injury: Clinical Characteristics and a Prognostic Model of 12-Month Outcome. World Neurosurg. 2018;114:e1199-e1210. PubMed PMID: 29614364.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Moderate Traumatic Brain Injury: Clinical Characteristics and a Prognostic Model of 12-Month Outcome. AU - Einarsen,Cathrine Elisabeth, AU - van der Naalt,Joukje, AU - Jacobs,Bram, AU - Follestad,Turid, AU - Moen,Kent Gøran, AU - Vik,Anne, AU - Håberg,Asta Kristine, AU - Skandsen,Toril, Y1 - 2018/03/31/ PY - 2017/12/23/received PY - 2018/03/23/revised PY - 2018/03/24/accepted PY - 2018/4/4/pubmed PY - 2018/6/9/medline PY - 2018/4/4/entrez KW - Cohort studies KW - Comparative study KW - Craniocerebral trauma KW - Prognosis KW - Statistical models SP - e1199 EP - e1210 JF - World neurosurgery JO - World Neurosurg VL - 114 N2 - BACKGROUND: Patients with moderate traumatic brain injury (TBI) often are studied together with patients with severe TBI, even though the expected outcome of the former is better. Therefore, we aimed to describe patient characteristics and 12-month outcomes, and to develop a prognostic model based on admission data, specifically for patients with moderate TBI. METHODS: Patients with Glasgow Coma Scale scores of 9-13 and age ≥16 years were prospectively enrolled in 2 level I trauma centers in Europe. Glasgow Outcome Scale Extended (GOSE) score was assessed at 12 months. A prognostic model predicting moderate disability or worse (GOSE score ≤6), as opposed to a good recovery, was fitted by penalized regression. Model performance was evaluated by area under the curve of the receiver operating characteristics curves. RESULTS: Of the 395 enrolled patients, 81% had intracranial lesions on head computed tomography, and 71% were admitted to an intensive care unit. At 12 months, 44% were moderately disabled or worse (GOSE score ≤6), whereas 8% were severely disabled and 6% died (GOSE score ≤4). Older age, lower Glasgow Coma Scale score, no day-of-injury alcohol intoxication, presence of a subdural hematoma, occurrence of hypoxia and/or hypotension, and preinjury disability were significant predictors of GOSE score ≤6 (area under the curve = 0.80). CONCLUSIONS: Patients with moderate TBI exhibit characteristics of significant brain injury. Although few patients died or experienced severe disability, 44% did not experience good recovery, indicating that follow-up is needed. The model is a first step in development of prognostic models for moderate TBI that are valid across centers. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/29614364/Moderate_Traumatic_Brain_Injury:_Clinical_Characteristics_and_a_Prognostic_Model_of_12_Month_Outcome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(18)30658-2 DB - PRIME DP - Unbound Medicine ER -