title: Predicting intracranial hemorrhage after traumatic brain injury in low and middle-income countries: a prognostic model based on a large, multi-center, international cohort.
abstract: BACKGROUND
  Traumatic brain injury (TBI) affects approximately 10 million people annually, of which intracranial hemorrhage is a devastating sequelae, occurring in one-third to half of cases. Patients in low and middle-income countries (LMIC) are twice as likely to die following TBI as compared to those in high-income countries. Diagnostic capabilities and treatment options for intracranial hemorrhage are limited in LMIC as there are fewer computed tomography (CT) scanners and neurosurgeons per patient as in high-income countries.
  
  
  METHODS
  The Medical Research Council CRASH-1 trial was utilized to build this model. The study cohort included all patients from LMIC who received a CT scan of the brain (n = 5669). Prognostic variables investigated included age, sex, time from injury to randomization, pupil reactivity, cause of injury, seizure and the presence of major extracranial injury.
  
  
  RESULTS
  There were five predictors that were included in the final model; age, Glasgow Coma Scale, pupil reactivity, the presence of a major extracranial injury and time from injury to presentation. The model demonstrated good discrimination and excellent calibration (c-statistic 0.71). A simplified risk score was created for clinical settings to estimate the percentage risk of intracranial hemorrhage among TBI patients.
  
  
  CONCLUSIONS
  Simple prognostic models can be used in LMIC to estimate the risk of intracranial hemorrhage among TBI patients. Combined with clinical judgment this may facilitate risk stratification, rapid transfer to higher levels of care and treatment in resource-poor settings.
authors.affiliation: Department of Emergency Medicine, New York Presbyterian, New York, NY, USA. sas9141@nyp.org
authors.forename: Saleena
authors.initials: S
authors.lastname: Subaiya
authors.forename: Ian
authors.initials: I
authors.lastname: Roberts
authors.forename: Edward
authors.initials: E
authors.lastname: Komolafe
authors.forename: Pablo
authors.initials: P
authors.lastname: Perel
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D003906:Developing Countries; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D017678:Sex Distribution; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult