Abstract
In Japan, a range of patients with traumatic brain injury (TBI) has been recorded in a nationwide database (Japan Neurotrauma Data Bank; JNTDB). This study aimed to externally validate three international prediction models using JNTDB data: Trauma and Injury Severity Score (TRISS), Corticosteroid Randomization After Significant Head Injury (CRASH), and International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT). We also aimed to validate the applicability of these models in the Japanese population. Of 1,091 patients registered in the JNTDB from July 2009 to June 2011, we analyzed data for 635 patients. We examined factors associated with mortality in-hospital and unfavorable outcomes 6 months after TBI by applying the TRISS, CRASH, and IMPACT models. We also conducted an external validation of these models based on these data. The patients’ mean age was 60.1 ±21.1 years, and 342 were alive at the time of discharge (53.9%). Univariate analysis revealed eight major risk factors for mortality in-hospital: age, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), systolic blood pressure, heart rate, mydriasis, acute epidural hematoma (AEDH), and traumatic subarachnoid hemorrhage. A similar analysis identified five risk factors for unfavorable outcomes at 6 months: age, GCS, ISS, mydriasis, and AEDH. For mortality in-hospital, the TRISS had a satisfactory area under the curve value (0.75). For unfavorable outcomes at 6 months, the CRASH (basic and computed tomography) and IMPACT (core and core extended) models had satisfactory area under the curve values (0.86, 0.86, 0.81, and 0.85, respectively). The TRISS, CRASH, and IMPACT models were suitable for application to the JNTDB population, indicating these models had high value in Japanese patients with neurotrauma.
Highlights
Traumatic head injury is a major cause of death [1]
Logistic analysis of the three systolic blood pressure (SBP) groups showed statistically significant differences among the groups (p
No special tendency in terms of mortality was observed in relation to respiratory rate (RR), but high serum glucose (SG) and the presence of mydriasis were risk factors for mortality
Summary
Practitioners are requested to identify patients with such injuries who will survive after arrival at the emergency department, and start appropriate medical practice immediately. For this reason, many attempts to establish appropriate prediction models have been conducted worldwide [2,3,4,5,6,7,8,9,10,11,12,13,14]. Available models include the Abbreviated Injury Scale developed by the Association for the Advancement of Automobile Medicine [2] and the Injury Severity Score (ISS) for evaluating emergency care for multiple injuries [3]. The modified Kampala [10], Trauma Mortality Prediction Model [11], and modified McPeek [12] were further suggested as models that improved prediction accuracy
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