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Papers of the Week

2021 May 06

J Neurotrauma

A Prognostic Model for Predicting 1-Month Outcomes Among Emergency Department Patients With Mild Traumatic Brain Injury and a Presenting Glasgow Coma Scale of 15.


Falk H, Bechtold K, Peters M, Roy D, Rao V, Lavieri MS, Sair HI, Van Meter TE, Korley F K
J Neurotrauma. 2021 May 06.
PMID: 33957761.


The lack of well-performing prognostic models for early prognostication of outcomes remains a major barrier to improving the clinical care of patients with mild traumatic brain injury (mTBI). We aimed to derive a prognostic model for predicting incomplete recovery at 1-month in emergency department (ED) patients with mTBI and a presenting Glasgow Coma Scale (GCS) of 15 who were enrolled in the HeadSMART (Head Injury Serum Markers for Assessing Response to Trauma) study. The derivation cohort included 355 participants with complete follow-up data. The primary outcome measure was the Glasgow Outcome Scale Extended (GOSE) at 1-month and incomplete recovery was defined as a GOSE<8. At 1-month post-injury, incomplete recovery was present in 58% (n=205) of participants. The final multivariable logistic regression model included six variables: age in years (OR= 0.98; 95% CI: 0.97-1.00), positive head CT (OR=4.42; 95% CI: 2.21-9.33), history of depression (OR=2.59; 95% CI: 1.47-4.69), and self-report of moderate or severe headache (OR=2.49; 95% CI: 1.49-4.18), difficulty concentrating (OR=3.17; 95% CI: 1.53-7.04), and photophobia (OR=4.17; 95% CI: 2.08-8.92) on the day of injury. The model was validated internally using bootstrap resampling (1000 resamples), which revealed a mean over-optimism value of 0.01 and an optimism-corrected area under the curve of 0.79 (95% CI: 0.75-0.85). A prognostic model for predicting incomplete recovery among ED patients with mTBI and a presenting GCS of 15 using easily obtainable clinical and demographic variables has acceptable discriminative accuracy. External validation of this model is warranted.