title: The application of IMPACT prognostic models to elderly adults with traumatic brain injury: A population-based observational cohort study.
abstract: OBJECTIVE
  To examine the performance of the International Mission for Prognosis and Clinical Trial Design in Traumatic Brain Injury (IMPACT) prognostic models in older patients.
  
  
  METHODS
  Using data from the National Study on Costs and Outcomes of Trauma (NSCOT), this study identified adult patients presenting to US hospitals in 2001 and 2002 with non-penetrating moderate or severe traumatic brain injury (GCS ≤ 12). IMPACT model calibration and discrimination in the older stratum (65-84 years) was compared to that in the younger stratum (18-64 years).
  
  
  RESULTS
  IMPACT model discrimination did not differ significantly between the older (n = 202; weighted n = 268) and younger strata (n = 613; weighted n = 1632) and was generally adequate (c-statistic for the core-death model = 0.81 [0.77-0.84] vs 0.75 [0.66-0.84], respectively; p = 0.26). IMPACT model calibration was poor for both older and younger strata (Hosmer-Lemeshow p-value for the core-death model = 0.01 vs < 0.0001, respectively). Pre-specified qualitative graphical evaluation suggested substantial under-prediction of mortality in the oldest decades of life, but not among younger patients.
  
  
  CONCLUSIONS
  The examined IMPACT prognostic models demonstrated adequate discrimination and poor calibration in both older and younger patients, yet particular caution may be required when applying these models to the elderly.
authors.affiliation: a Department of Medicine , University of British Columbia , Vancouver , Canada.|b Department of Medicine , University of Washington , Seattle , WA , USA.|c Harborview Injury Prevention and Research Center , Seattle , WA , USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Staples
authors.affiliation: c Harborview Injury Prevention and Research Center , Seattle , WA , USA.
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.affiliation: b Department of Medicine , University of Washington , Seattle , WA , USA.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Zaros
authors.affiliation: d Department of Surgery , University of Colorado , Denver , CO , USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Jurkovich
authors.affiliation: c Harborview Injury Prevention and Research Center , Seattle , WA , USA.|e Department of Pediatrics , University of Washington , Seattle , WA , USA.
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011379:Prognosis; D055815:Young Adult
keywords: IMPACT score; Traumatic brain injury; geriatric patients; prognosis