Chinese Admission Warning Strategy for Predicting the Hospital Discharge Outcome in Patients with Traumatic Brain Injury.

Ruizhe Zheng,Shuming Pan,Yue Zhou,Keqin Li,Yanbin Ma,Zhijie Zhao,Yang Wang,Zhongwei Zhuang,Xitao Yang,Qiong Huang,Changyi Zhao,Kui Chen

doi:10.3390/jcm11040974

Abstract

Objective: To develop and validate an admission warning strategy that incorporates the general emergency department indicators for predicting the hospital discharge outcome of patients with traumatic brain injury (TBI) in China. Methods: This admission warning strategy was developed in a primary cohort that consisted of 605 patients with TBI who were admitted within 6 h of injury. The least absolute shrinkage and selection operator and multivariable logistic regression analysis were used to develop the early warning strategy of selected indicators. Two sub-cohorts consisting of 180 and 107 patients with TBI were used for the external validation. Results: Indicators of the strategy included three categories: baseline characteristics, imaging and laboratory indicators. This strategy displayed good calibration and good discrimination. A high C-index was reached in the internal validation. The multicenter external validation cohort still showed good discrimination C-indices. Decision curve analysis (DCA) showed the actual needs of this strategy when the possibility threshold was 0.01 for the primary cohort, and at thresholds of 0.02–0.83 and 0.01–0.88 for the two sub-cohorts, respectively. In addition, this strategy exhibited a significant prognostic capacity compared to the traditional single predictors, and this optimization was also observed in two external validation cohorts. Conclusions: We developed and validated an admission warning strategy that can be quickly deployed in the emergency department. This strategy can be used as an ideal tool for predicting hospital discharge outcomes and providing objective evidence for early informed consent of the hospital discharge outcome to the family members of TBI patients.

Highlights

Introduction conditions of the Creative CommonsAffecting approximately 18% of the world population and with an annual incidence of over 50 million, the absolute numbers of patients with traumatic brain injury (TBI) inChina have exceeded those of most other countries [1,2]
892 patients with TBI were assessed for eligibility between January 2018 and May 2019, for whom no significant difference was observed according to the clinical characteristics between the internal validation cohort (605 patients) and the two external validation cohorts (180 and 107 patients)
(RTS),injury injuryseverity severityscore score(ISS), (ISS),exponential exponentialinjury injuryseverity severityscore score(EISS), (EISS),and andtraumatic traumatic (RTS), injury mortality mortality prediction are soso influenced by injury prediction (TRIMP), (TRIMP),have havebeen beenwidely widelyaccepted, accepted,they they are influenced the anatomical index and the accuracy of specific anatomical injury site is by the anatomical index and the accuracy of specific anatomical injury site limited [29]

Summary

Introduction

Affecting approximately 18% of the world population and with an annual incidence of over 50 million, the absolute numbers of patients with traumatic brain injury (TBI) in. China have exceeded those of most other countries [1,2]. With an approximately 27% mortality and with over 50% having an unfavorable outcome of severe TBI, TBI is still a major concern in China [2–4]. With improvements in TBI management in China (e.g., the issuing of a series of guidelines and consensus reports) [1], the treatment level of TBI in the majority of hospitals is normalizing, and increasing numbers of senior neurologists have the ability to predict the outcome of TBI. There is increasing interest in the discovery of novel biomarkers and the development of advanced technical means for predicting outcomes following

Methods

Results

Conclusion