Prediction of Global Functional Outcome and Post-Concussive Symptoms after Mild Traumatic Brain Injury: External Validation of Prognostic Models in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study
Mikolic, Ana; Polinder, Suzanne; Steyerberg, Ewout W; Retel Helmrich, Isabel; Giacino, Joseph T.; Maas, Andrew I.R.; van der Naalt, Joukje; Voormolen, Daphne; von Steinbüchel, Nicole; Wilson, Lindsay; Lingsma, Hester F; van Klaveren, David; Andelic, Nada; Andreassen, Lasse; Anke, Audny; Frisvold, Shirin; Helseth, Eirik; Røe, Cecilie; Røise, Olav; Skandsen, Toril; Vik, Anne; Åkerlund, Cecilia; Amrein, Krisztina; Antoni, Anna; Audibert, Gerard; Azouvi, Philippe; Azzolini, Maria Luisa; Bartels, Ronald; Barzo, Pal; Beauvais, Romuald; Beer, Ronny; Bellander, Bo-Michael; Belli, Antonio; Benali, Habib; Berardino, Maurizio; Beretta, Luigi; Blaabjerg, Morten; Bragge, Peter; Brazinova, Alexandra; Brinck, Vibeke; Brooker, Joanne; Brorsson, Camilla; Buki, Andras; Bullinger, Monika; Cabeleira, Manuel; Caccioppola, Alessio; Calappi, Emiliana; Calvi, Maria Rosa; Cameron, Peter; Lozano, Guillermo Carbayo; Carbonara, Marco
Peer reviewed, Journal article
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Date
2020Metadata
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Abstract
The majority of traumatic brain injuries (TBIs) are categorized as mild, according to a baseline Glasgow Coma Scale (GCS) score of 13–15. Prognostic models that were developed to predict functional outcome and persistent post-concussive symptoms (PPCS) after mild TBI have rarely been externally validated. We aimed to externally validate models predicting 3–12-month Glasgow Outcome Scale Extended (GOSE) or PPCS in adults with mild TBI. We analyzed data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) project, which included 2862 adults with mild TBI, with 6-month GOSE available for 2374 and Rivermead Post-Concussion Symptoms Questionnaire (RPQ) results available for 1605 participants. Model performance was evaluated based on calibration (graphically and characterized by slope and intercept) and discrimination (C-index). We validated five published models for 6-month GOSE and three for 6-month PPCS scores. The models used different cutoffs for outcome and some included symptoms measured 2 weeks post-injury. Discriminative ability varied substantially (C-index between 0.58 and 0.79). The models developed in the Corticosteroid Randomisation After Significant Head Injury (CRASH) trial for prediction of GOSE