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Outcome Prediction in Moderate and Severe Traumatic Brain Injury: A Focus on Computed Tomography Variables

Neurocritical Care volume 19, pages 79–89 (2013)Cite this article

Abstract

Background

With this study we aimed to design validated outcome prediction models in moderate and severe traumatic brain injury (TBI) using demographic, clinical, and radiological parameters.

Methods

Seven hundred consecutive moderate or severe TBI patients were included in this observational prospective cohort study. After inclusion, clinical data were collected, initial head computed tomography (CT) scans were rated, and at 6 months outcome was determined using the extended Glasgow Outcome Scale. Multivariate binary logistic regression analysis was applied to evaluate the association between potential predictors and three different outcome endpoints. The prognostic models that resulted were externally validated in a national Dutch TBI cohort.

Results

In line with previous literature we identified age, pupil responses, Glasgow Coma Scale score and the occurrence of a hypotensive episode post-injury as predictors. Furthermore, several CT characteristics were associated with outcome; the aspect of the ambient cisterns being the most powerful. After external validation using Receiver Operating Characteristic (ROC) analysis our prediction models demonstrated adequate discriminative values, quantified by the area under the ROC curve, of 0.86 for death versus survival and 0.83 for unfavorable versus favorable outcome. Discriminative power was less for unfavorable outcome in survivors: 0.69.

Conclusions

Outcome prediction in moderate and severe TBI might be improved using the models that were designed in this study. However, conventional demographic, clinical and CT variables proved insufficient to predict disability in surviving patients. The information that can be derived from our prediction rules is important for the selection and stratification of patients recruited into clinical TBI trials.

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Acknowledgments

The authors wish to thank Ronald H.M.A. Bartels, MD, PhD of the Department of Neurosurgery, Radboud University Nijmegen Medical Centre, for critically reviewing this manuscript and his suggestions, and Robert Huiskes for the development of the prognostic calculator and the website www.tbi-prognosis.com. The POCON study is funded by the Dutch Brain Foundation (Hersenstichting - HSN-07-01). The authors express their gratitude to Dick Drost, Annemiek Coers, Annelou van der Veen, Joshua Field, Vivian de Ruijter, and Heleen Biersteker for their help with data collection. Amon Heijne is thanked for his help with the development and maintenance of the POCON database.

Conflict of interest

All authors declare no conflict of interest to disclose.

Author information

Author notes

  1. Bram Jacobs

    Present address: Department of Neurology (AB51), University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands

  2. Ton M. van der Vliet

    Present address: Department of Radiology, University Medical Centre Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands

  3. Arie B. van Vugt

    Present address: Department of Surgery, Medisch Spectrum Twente, P.O. Box 50.000, 7500 KA, Enschede, The Netherlands

Affiliations

  1. Department of Neurology (935), Radboud University Nijmegen Medical Centre (RUNMC), P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    Bram Jacobs, Teuntje M. J. C. Andriessen & Pieter E. Vos

  2. Department of Neurosurgery (931), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    Tjemme Beems

  3. Department of Radiology, RUNMC, Nijmegen, The Netherlands

    Ton M. van der Vliet

  4. Department of Emergency Medicine, RUNMC, Nijmegen, The Netherlands

    Arie B. van Vugt

  5. Department of Intensive Care Medicine (632), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    Cornelia Hoedemaekers

  6. Department of Intensive Care Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Janneke Horn

  7. Department of Anesthesiology, VU University Medical Centre, Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands

    Gaby Franschman

  8. Department of Neurosurgery, Erasmus Medical Centre, Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands

    Ian Haitsma

  9. Department of Neurology, University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands

    Joukje van der Naalt

  10. Department of Epidemiology, Biostatistics and HTA (133), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    George F. Borm

Authors
  1. Bram Jacobs
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  2. Tjemme Beems
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  3. Ton M. van der Vliet
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  6. Janneke Horn
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  7. Gaby Franschman
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  9. Joukje van der Naalt
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  10. Teuntje M. J. C. Andriessen
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  11. George F. Borm
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  12. Pieter E. Vos
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Corresponding author

Correspondence to Pieter E. Vos.

Additional information

Tjemme Beems—Deceased.

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Jacobs, B., Beems, T., van der Vliet, T.M. et al. Outcome Prediction in Moderate and Severe Traumatic Brain Injury: A Focus on Computed Tomography Variables. Neurocrit Care 19, 79–89 (2013). https://doi.org/10.1007/s12028-012-9795-9

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  • DOI: https://doi.org/10.1007/s12028-012-9795-9

Keywords

  • Moderate traumatic brain injury
  • Severe traumatic brain injury
  • Outcome
  • Prediction model
  • CT-scan
  • Head injury