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Prognostic Models for Global Functional Outcome and Post-Concussion Symptoms Following Mild Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study

Publiceringsår

2023

Upphovspersoner

Mikolić, Ana; Steyerberg, Ewout W.; Polinder, Suzanne; Wilson, Lindsay; Zeldovich, Marina; von Steinbueche, Nicole; Newcombe, Virginia F.J.; Menon, David K.; van der Naalt, Joukje; Lingsma, Hester F.; Maas, Andrew I.R.; van Klaveren, David; Åkerlund, Cecilia; Amrein, Krisztina; Andelic, Nada; Andreassen, Lasse; Anke, Audny; Antoni, Anna; Audibert, Gérard; Azouvi, Philippe; Azzolini, Maria Luisa; Bartels, Ronald; Barzó, Pál; 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; Carbayo Lozano, Guillermo; Carbonara, Marco; Cavallo, Simona; Chevallard, Giorgio; Chieregato, Arturo; Citerio, Giuseppe; Ylén, Peter; CENTER-TBI participants and investigators
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Abstrakt

<p>After mild traumatic brain injury (mTBI), a substantial proportion of individuals do not fully recover on the Glasgow Outcome Scale Extended (GOSE) or experience persistent post-concussion symptoms (PPCS). We aimed to develop prognostic models for the GOSE and PPCS at 6 months after mTBI and to assess the prognostic value of different categories of predictors (clinical variables; questionnaires; computed tomography [CT]; blood biomarkers). From the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we included participants aged 16 or older with Glasgow Coma Score (GCS) 13-15. We used ordinal logistic regression to model the relationship between predictors and the GOSE, and linear regression to model the relationship between predictors and the Rivermead Post-concussion Symptoms Questionnaire (RPQ) total score. First, we studied a pre-specified Core model. Next, we extended the Core model with other clinical and sociodemographic variables available at presentation (Clinical model). The Clinical model was then extended with variables assessed before discharge from hospital: early post-concussion symptoms, CT variables, biomarkers, or all three categories (extended models). In a subset of patients mostly discharged home from the emergency department, the Clinical model was extended with 2-3–week post-concussion and mental health symptoms. Predictors were selected based on Akaike’s Information Criterion. Performance of ordinal models was expressed as a concordance index (C) and performance of linear models as proportion of variance explained (R2). Bootstrap validation was used to correct for optimism. We included 2376 mTBI patients with 6-month GOSE and 1605 patients with 6-month RPQ. The Core and Clinical models for GOSE showed moderate discrimination (C = 0.68 95% confidence interval 0.68 to 0.70 and C = 0.70[0.69 to 0.71], respectively) and injury severity was the strongest predictor. The extended models had better discriminative ability (C = 0.71[0.69 to 0.72] with early symptoms; 0.71[0.70 to 0.72] with CT variables or with blood biomarkers; 0.72[0.71 to 0.73] with all three categories). The performance of models for RPQ was modest (R2 = 4% Core; R2 = 9% Clinical), and extensions with early symptoms increased the R2 to 12%. The 2-3-week models had better performance for both outcomes in the subset of participants with these symptoms measured (C = 0.74 [0.71 to 0.78] vs. C = 0.63[0.61 to 0.67] for GOSE; R2 = 37% vs. 6% for RPQ). In conclusion, the models based on variables available before discharge have moderate performance for the prediction of GOSE and poor performance for the prediction of PPCS. Symptoms assessed at 2-3 weeks are required for better predictive ability of both outcomes. The performance of the proposed models should be examined in independent cohorts.</p>
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Organisationer och upphovspersoner

Helsingfors universitet

Palotie Aarno

Piippo-Karjalainen Anna

Pirinen Matti

Raj Rahul

Ripatti Samuli

Helsingforsregionens universitetscentralsjukhus specialupptagningsområde

Palotie Aarno

Piippo-Karjalainen Anna

Pirinen Matti

Raj Rahul

Ripatti Samuli

Publikationstyp

Publikationsform

Artikel

Moderpublikationens typ

Tidning

Artikelstyp

En originalartikel

Målgrupp

Vetenskaplig

Kollegialt utvärderad

Kollegialt utvärderad

UKM:s publikationstyp

A1 Originalartikel i en vetenskaplig tidskrift

Publikationskanalens uppgifter

Moderpublikationens namn

Journal of Neurotrauma

Volym

40

Nummer

15-16

Sidor

1651-1670

Publikationsforum

61164

Publikationsforumsnivå

2

Öppen tillgång

Öppen tillgänglighet i förläggarens tjänst

Ja

Öppen tillgång till publikationskanalen

Delvis öppen publikationskanal

Licens för förläggarens version

CC BY

Parallellsparad

Ja

Parallellagringens licens

CC BY

Övriga uppgifter

Vetenskapsområden

Medicinsk teknik; Neurovetenskaper

Nyckelord

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Publiceringsland

Förenta staterna (USA)

Förlagets internationalitet

Internationell

Språk

engelska

Internationell sampublikation

Ja

Sampublikation med ett företag

Ja

DOI

10.1089/neu.2022.0320

Publikationen ingår i undervisnings- och kulturministeriets datainsamling

Ja