title: The application of adult traumatic brain injury models in a pediatric cohort.
abstract: OBJECTIVE There is increasing interest in the use of predictive models of outcome in adult head injury. Two international models have been identified to be reliable modalities for predicting outcome: the Corticosteroid Randomisation After Significant Head Injury (CRASH) model, and the International Mission on Prognosis and Analysis of randomized Controlled Trials in TBI (IMPACT) model. However, these models are designed only to identify outcomes in adult populations. METHODS A retrospective analysis was performed on pediatric patients with severe traumatic brain injury (TBI) admitted to the pediatric intensive care unit (PICU) of Addenbrooke's Hospital between January 2009 and December 2013. The individual risk of 14-day mortality was calculated using the CRASH-Basic and -CT models, and the risk of 6-month mortality calculated using the IMPACT-Core and -Extended (including CT findings) models. Model accuracy was determined by standardized mortality ratio (SMtR; observed/expected deaths), discrimination was evaluated as the area under the receiver operating curve (AUROC), and calibration assessed using the Hosmer-Lemeshow χ2test. RESULTS Ninety-four patients with an average age of 7.3 years were admitted to the PICU with a TBI. The mortality rate was 12.7% at 14 days and at 6 months. For the CRASH-Basic model, the SMtR was 1.42 and both calibration (χ2= 6.1, p = 0.64) and discrimination (AUROC = 0.92) were good. For the IMPACT-Core model, the SMtR was 1.03 and the model was also well calibrated (χ2= 8.99, p = 0.34) and had good discrimination (AUROC = 0.85). Poor outcome was observed in 17% of the cohort and identified with the CRASH-Basic and IMPACT-Core models to varying degrees: standardized morbidity ratio = 0.89 vs 0.67, respectively; calibration = 6.5 (χ2) and 0.59 (p value) versus 8.52 (χ2) and 0.38 (p value), respectively; and discrimination (AUROC) = 0.92 versus 0.83, respectively. CONCLUSIONS Adult head injury models may be applied with sufficient accuracy to identify predictors of morbidity and mortality in pediatric TBI.
authors: Division of Academic Neurosurgery, Department of Clinical Neurosciences, and.
authors: Adam M H
authors: AM
authors: Young
authors: Division of Academic Neurosurgery, Department of Clinical Neurosciences, and.
authors: Mathew R
authors: MR
authors: Guilfoyle
authors: Division of Academic Neurosurgery, Department of Clinical Neurosciences, and.
authors: Helen
authors: H
authors: Fernandes
authors: Division of Academic Neurosurgery, Department of Clinical Neurosciences, and.
authors: Matthew R
authors: MR
authors: Garnett
authors: Department of Paediatric Intensive Care, Addenbrooke's Hospital, University of Cambridge, United Kingdom.
authors: Shruti
authors: S
authors: Agrawal
authors: Division of Academic Neurosurgery, Department of Clinical Neurosciences, and.
authors: Peter J
authors: PJ
authors: Hutchinson
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D015233:Models, Statistical; D010343:Patient Admission / Q000639:trends; D012189:Retrospective Studies
keywords: AUROC = area under the receiver operating curve; CRASH = Corticosteroid Randomisation After Significant Head Injury; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; IMPACT = International Mission on Prognosis and Analysis of randomized Controlled Trials in TBI; IQR = interquartile range; PICU = pediatric intensive care unit; SMbR = standardized morbidity ratio; SMtR = standardized mortality ratio; TBI = traumatic brain injury; acute; brain; injury; prediction; trauma