Performance of CRASH and IMPACT Prognostic Models for Traumatic Brain Injury at 12 and 24 Months Post-Injury.

Autor:	Eagle SR; Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Nwachuku E; Department of Neurological Surgery, Cleveland Clinic, Akron, Ohio, USA., Elmer J; Department of Clinical Care Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Deng H; Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Okonkwo DO; Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Pease M; Department of Neurological Surgery, Memorial Sloan Kettering, New York, New York, USA.
Jazyk:	angličtina
Zdroj:	Neurotrauma reports [Neurotrauma Rep] 2023 Mar 01; Vol. 4 (1), pp. 118-123. Date of Electronic Publication: 2023 Mar 01 (Print Publication: 2023).
DOI:	10.1089/neur.2022.0082
Abstrakt:	The Corticoid Randomization after Significant Head Injury (CRASH) and International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) prognostic models are the most reported prognostic models for traumatic brain injury (TBI) in the scientific literature. However, these models were developed and validated to predict 6-month unfavorable outcome and mortality, and growing evidence supports continuous improvements in functional outcome after severe TBI up to 2 years post-injury. The purpose of this study was to evaluate CRASH and IMPACT model performance beyond 6 months post-injury to include 12 and 24 months post-injury. Discriminative validity remained consistent over time and comparable to earlier recovery time points (area under the curve = 0.77-0.83). Both models had poor fit for unfavorable outcomes, explaining less than one quarter of the variation in outcomes for severe TBI patients. The CRASH model had significant values for the Hosmer-Lemeshow test at 12 and 24 months, indicating poor model fit past the previous validation point. There is concern in the scientific literature that TBI prognostic models are being used by neurotrauma clinicians to support clinical decision making despite the goal of the models' development being to support research study design. The results of this study indicate that the CRASH and IMPACT models should not be used in routine clinical practice because of poor model fit that worsens over time and the large, unexplained variance in outcomes. Competing Interests: No competing financial interests exist. (© Shawn R. Eagle et al., 2023; Published by Mary Ann Liebert, Inc.)
Databáze:	MEDLINE
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