Abstract
Objective: To identify reproducible sub-classes of traumatic brain injury (TBI) that correlate with patient outcomes.Methods: Two TBI datasets from the Federal Interagency Traumatic Brain Injury Research (FITBIR) Informatics System were utilized, Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot and Citicoline Brain Injury Treatment Trial (COBRIT). Patients included in these analyses had closed head injuries with Glasgow Comas Scale (GCS) scores of 13–15 at arrival at the Emergency Department (ED). Sparse hiearchical clustering was applied to identify TBI sub-classes within each dataset. The reproducibility of the sub-classes was evaluated by investigating similarities in clinical variable profiles and patient outcomes in each sub-class between the two datasets, as well as by using a statistical metric called in-group proportion (IGP).Results: Seven TBI sub-classes were identified in the first dataset. There were between-class differences in patient outcomes at 90 days (Glasgow Outcome Scale Extended (GOSE): p < 0.001) and 180 days (Trail Making Test (TMT): p = 0.03). Four of seven sub-classes were reproducible in the second dataset with very high IGPs (94, 100, 99, 97%). Seven TBI sub-classes were also identified in the second dataset. There were significant between-class differences in patient outcomes at 180 days (GOSE: p = 0.024; Brief Symptom Inventory (BSI) p = 0.007; TMT: p < 0.001). Three of seven sub-classes were reproducible in the second dataset with very high IGPs (100% for all).Conclusions: Reproducible TBI sub-classes were identified across two independent datasets, suggesting that these sub-classes exist in a general population. Differences in patient outcomes according to sub-class assignment suggest that this sub-classification could be used to guide post-TBI prognosis.
Highlights
Traumatic brain injury (TBI) severity is sub-classified into “mild,” “moderate,” and “severe” categories based upon Glasgow Coma Scale (GCS) scores [1]
To assess how the sub-classification results can help inform outcome prognosis we focused on sub-classes D, E, and G that were found in COBRIT and reproducible in TRACK-TBI
Their study is different from ours in the following aspects: [1] their clustering structure was found from clinical variables and outcomes at 180 days, while our clustering structure was based on clinical variables available at the time of initial clinical evaluation; [2] subtypes found in their study were evaluated by correlating with genetic information, but the subtypes we discovered were evaluated by correlating with post-TBI outcomes at 90 and 180 days; [3] their study focused on a single dataset, while ours was a cross-study of two datasets to find reproducible sub-classes
Summary
Traumatic brain injury (TBI) severity is sub-classified into “mild,” “moderate,” and “severe” categories based upon Glasgow Coma Scale (GCS) scores [1]. Si et al previously performed a study in 2018 that classified mild TBI patients into sub-classes using patients’ gender, employment, marital status, use of alcohol, use of tobacco, history of neurologic disease, history of psychiatric disease, injury mechanism and a few additional characteristics collected during the Emergency Department (ED) visit including head CT results, diastolic and systolic blood pressure, and use of intravenous fluids [3]. The previous study focused on finding sub-classes from a single dataset, Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACKTBI) Pilot [4]. Sub-classification is more clinically relevant if the sub-classes found in one patient population are reproducible in other patient populations
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