title: A model to predict progression in brain-injured patients.
abstract: BACKGROUND
  The study of brain death (BD) epidemiology and the acute brain injury (ABI) progression profile is important to improve public health programs, organ procurement strategies, and intensive care unit (ICU) protocols. The purpose of this study was to analyze the ABI progression profile among patients admitted to ICUs with a Glasgow Coma Score (GCS) ≤8, as well as establishing a prediction model of probability of death and BD.
  
  
  METHODS
  This was a retrospective analysis of prospective data that included all brain-injured patients with GCS ≤8 admitted to a total of four public and private ICUs in Uruguay (N = 1447). The independent predictor factors of death and BD were studied using logistic regression analysis. A hierarchical model consisting of 2 nested logit regression models was then created. With these models, the probabilities of death, BD, and death by cardiorespiratory arrest were analyzed.
  
  
  RESULTS
  In the first regression, we observed that as the GCS decreased and age increased, the probability of death rose. Each additional year of age increased the probability of death by 0.014. In the second model, however, BD risk decreased with each year of age. The presence of swelling, mass effect, and/or space-occupying lesion increased BD risk for the same given GCS. In the presence of injuries compatible with intracranial hypertension, age behaved as a protective factor that reduced the probability of BD.
  
  
  CONCLUSIONS
  Based on the analysis of the local epidemiology, a model to predict the probability of death and BD can be developed. The organ potential donation of a country, region, or hospital can be predicted on the basis of this model, customizing it to each specific situation.
authors.affiliation: National Institute of Donation and Transplantation (INDT), Montevideo, Uruguay. Electronic address: nicotommasino@gmail.com.
authors.forename: N
authors.initials: N
authors.lastname: Tommasino
authors.affiliation: National Institute of Donation and Transplantation (INDT), Montevideo, Uruguay.
authors.forename: D
authors.initials: D
authors.lastname: Forteza
authors.affiliation: National Institute of Donation and Transplantation (INDT), Montevideo, Uruguay.
authors.forename: M
authors.initials: M
authors.lastname: Godino
authors.affiliation: National Institute of Donation and Transplantation (INDT), Montevideo, Uruguay.
authors.forename: R
authors.initials: R
authors.lastname: Mizraji
authors.affiliation: National Institute of Donation and Transplantation (INDT), Montevideo, Uruguay.
authors.forename: I
authors.initials: I
authors.lastname: Alvarez
mesh_terms: D000328:Adult; D000368:Aged; D001926:Brain Death / Q000175:diagnosis*; D001930:Brain Injuries / Q000401:mortality*; D003661:Decision Support Techniques; D005260:Female; D015600:Glasgow Coma Scale; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D009927:Tissue and Organ Procurement; D014583:Uruguay / Q000453:epidemiology