Prognostic performance of computerized tomography scoring systems in civilian penetrating traumatic brain injury : an observational study

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http://hdl.handle.net/10138/312599

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Lindfors , M , Lindblad , C , Nelson , D W , Bellander , B-M , Siironen , J , Raj , R & Thelin , E P 2019 , ' Prognostic performance of computerized tomography scoring systems in civilian penetrating traumatic brain injury : an observational study ' , Acta Neurochirurgica , vol. 161 , no. 12 , pp. 2467-2478 . https://doi.org/10.1007/s00701-019-04074-1

Title: Prognostic performance of computerized tomography scoring systems in civilian penetrating traumatic brain injury : an observational study
Author: Lindfors, Matias; Lindblad, Caroline; Nelson, David W.; Bellander, Bo-Michael; Siironen, Jari; Raj, Rahul; Thelin, Eric P.
Contributor: University of Helsinki, Neurokirurgian yksikkö
University of Helsinki, University of Helsinki
University of Helsinki, University of Helsinki
Date: 2019-12
Language: eng
Number of pages: 12
Belongs to series: Acta Neurochirurgica
ISSN: 0001-6268
URI: http://hdl.handle.net/10138/312599
Abstract: Background The prognosis of penetrating traumatic brain injury (pTBI) is poor yet highly variable. Current computerized tomography (CT) severity scores are commonly not used for pTBI prognostication but may provide important clinical information in these cohorts. Methods All consecutive pTBI patients from two large neurotrauma databases (Helsinki 1999-2015, Stockholm 2005-2014) were included. Outcome measures were 6-month mortality and unfavorable outcome (Glasgow Outcome Scale 1-3). Admission head CT scans were assessed according to the following: Marshall CT classification, Rotterdam CT score, Stockholm CT score, and Helsinki CT score. The discrimination (area under the receiver operating curve, AUC) and explanatory variance (pseudo-R-2) of the CT scores were assessed individually and in addition to a base model including age, motor response, and pupil responsiveness. Results Altogether, 75 patients were included. Overall 6-month mortality and unfavorable outcome were 45% and 61% for all patients, and 31% and 51% for actively treated patients. The CT scores' AUCs and pseudo-R(2)s varied between 0.77-0.90 and 0.35-0.60 for mortality prediction and between 0.85-0.89 and 0.50-0.57 for unfavorable outcome prediction. The base model showed excellent performance for mortality (AUC 0.94, pseudo-R-2 0.71) and unfavorable outcome (AUC 0.89, pseudo-R-2 0.53) prediction. None of the CT scores increased the base model's AUC (p > 0.05) yet increased its pseudo-R-2 (0.09-0.15) for unfavorable outcome prediction. Conclusion Existing head CT scores demonstrate good-to-excellent performance in 6-month outcome prediction in pTBI patients. However, they do not add independent information to known outcome predictors, indicating that a unique score capturing the intracranial severity in pTBI may be warranted.
Subject: Traumatic brain injury
Penetrating traumatic brain injury
Computerized tomography
Prognosis
Outcome prediction
CRANIOCEREBRAL GUNSHOT WOUNDS
HEAD-INJURY
CLASSIFICATION
MORTALITY
PREDICTORS
MANAGEMENT
SURVIVAL
MARSHALL
3112 Neurosciences
3124 Neurology and psychiatry
3126 Surgery, anesthesiology, intensive care, radiology
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