title: Outcome prediction in moderate and severe traumatic brain injury: a focus on computed tomography variables.
abstract: BACKGROUND
  With this study we aimed to design validated outcome prediction models in moderate and severe traumatic brain injury (TBI) using demographic, clinical, and radiological parameters.
  
  
  METHODS
  Seven hundred consecutive moderate or severe TBI patients were included in this observational prospective cohort study. After inclusion, clinical data were collected, initial head computed tomography (CT) scans were rated, and at 6 months outcome was determined using the extended Glasgow Outcome Scale. Multivariate binary logistic regression analysis was applied to evaluate the association between potential predictors and three different outcome endpoints. The prognostic models that resulted were externally validated in a national Dutch TBI cohort.
  
  
  RESULTS
  In line with previous literature we identified age, pupil responses, Glasgow Coma Scale score and the occurrence of a hypotensive episode post-injury as predictors. Furthermore, several CT characteristics were associated with outcome; the aspect of the ambient cisterns being the most powerful. After external validation using Receiver Operating Characteristic (ROC) analysis our prediction models demonstrated adequate discriminative values, quantified by the area under the ROC curve, of 0.86 for death versus survival and 0.83 for unfavorable versus favorable outcome. Discriminative power was less for unfavorable outcome in survivors: 0.69.
  
  
  CONCLUSIONS
  Outcome prediction in moderate and severe TBI might be improved using the models that were designed in this study. However, conventional demographic, clinical and CT variables proved insufficient to predict disability in surviving patients. The information that can be derived from our prediction rules is important for the selection and stratification of patients recruited into clinical TBI trials.
authors.affiliation: Department of Neurology (935), Radboud University Nijmegen Medical Centre (RUNMC), P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. B.Jacobs@umcg.nl
authors.forename: Bram
authors.initials: B
authors.lastname: Jacobs
authors.forename: Tjemme
authors.initials: T
authors.lastname: Beems
authors.forename: Ton M
authors.initials: TM
authors.lastname: van der Vliet
authors.forename: Arie B
authors.initials: AB
authors.lastname: van Vugt
authors.forename: Cornelia
authors.initials: C
authors.lastname: Hoedemaekers
authors.forename: Janneke
authors.initials: J
authors.lastname: Horn
authors.forename: Gaby
authors.initials: G
authors.lastname: Franschman
authors.forename: Ian
authors.initials: I
authors.lastname: Haitsma
authors.forename: Joukje
authors.initials: J
authors.lastname: van der Naalt
authors.forename: Teuntje M J C
authors.initials: TM
authors.lastname: Andriessen
authors.forename: George F
authors.initials: GF
authors.lastname: Borm
authors.forename: Pieter E
authors.initials: PE
authors.lastname: Vos
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000401:mortality*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D017741:Survivors; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards*; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D055815:Young Adult