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Predicted unfavorable neurological outcome is overestimated by the Marshall CT score, CRASH and IMPACT models in Severe TBI Patients management with early decompressive craniectomy.
World Neurosurg. 2017 Feb 18;:
Authors: Charry JD, Tejada JH, Pinzon MA, Tejada WA, Ochoa JD, Falla M, Tovar JH, Cuellar-Bahamón AM, Solano JP
Abstract
INTRODUCTION: Traumatic Brain Injury (TBI) is of public health interest and produces significant mortality and disability in Colombia. Calculators and prognostic models have been developed in order to establish neurologic outcome. We tested prognostic models (the Marshall CT score, IMPACT, and CRASH) for 14-day mortality, 6-month mortality, and 6-month outcome in TBI patients in a university Hospital in Colombia.
METHODS: A 127 patients' cohort with TBI was treated in a regional trauma center in Colombia over 2 years and Bivariate and Multivariate analyses were used. Discriminatory power of the models, its accuracy and precision was assessed by both logistic regression and area under the receiver operating characteristic curve (AUC). Shapiro Wilks, chi2 and Wilcoxon test were used to compare real outcomes in the cohort against predicted outcomes RESULTS: Group's median age was 33 years and 84, 25% was male. The ISS Median was 25 and median GSC motor score was 3. Six-month mortality was 29.13%. Six-month unfavorable outcome was 37%. Mortality prediction by Marshall CT score was 52.8% p=0.104 (AUC 0,585; 95% IC 0 0,489-0,681), the Mortality prediction by CRASH prognosis calculator was 59.9% p<0.001 (AUC 0,706; 95% IC 0,590-0,821), the unfavorable outcome prediction by IMPACT was 77% p<0.048 (AUC 0,670; 95% IC 0,575-0,763).
CONCLUSION: The Marshall CT score, IMPACT and CRASH models overestimate the adverse neurological outcome in patients with severe head trauma in a university hospital in Colombia.
PMID: 28223249 [PubMed - as supplied by publisher]
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