title: Predicting survival after acute civilian penetrating brain injuries: The SPIN score.
abstract: OBJECTIVE
  To identify predictors associated with survival in civilian penetrating traumatic brain injury (pTBI) utilizing a contemporary, large, diverse 2-center cohort, and to develop a parsimonious survival prediction score for pTBI.
  
  
  METHODS
  Our cohort comprised 413 pTBI patients retrospectively identified from the local trauma registries at 2 US level 1 trauma centers, of which one was predominantly urban and the other predominantly rural. Predictors of in-hospital and 6-month survival identified in univariate and multivariable logistic regression were used to develop the simple Surviving Penetrating Injury to the Brain (SPIN) score.
  
  
  RESULTS
  The mean age was 33 ± 16 years and patients were predominantly male (87%). Survival at hospital discharge as well as 6 months post pTBI was 42.4%. Higher motor Glasgow Coma Scale subscore, pupillary reactivity, lack of self-inflicted injury, transfer from other hospital, female sex, lower Injury Severity Score, and lower international normalized ratio were independently associated with survival (all p < 0.001; model area under the curve 0.962). Important radiologic factors associated with survival were also identified but their addition to the full multivariable would have resulted in model overfitting without much gain in the area under the curve.
  
  
  CONCLUSIONS
  The SPIN score, a logistic regression-based clinical risk stratification scale estimating survival after pTBI, was developed in this large, diverse 2-center cohort. While this preliminary clinical survival prediction tool does not include radiologic factors, it may support clinical decision-making after civilian pTBI if external validation confirms the probability estimates.
authors: From the Departments of Neurology (Neurocritical Care) (S.M., A.A.), Surgery (S.M., D.A., T.E.), and Anesthesia/Critical Care (S.M.), University of Massachusetts Medical School, Worcester; Department of Neurology (Division of Neurocritical Care) (S.I.), Massachusetts General Hospital and Brigham & Women's Hospital, Harvard Medical School, Boston; Department of Surgery (T.M.S., D.M.S.), R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore; and Departments of Neurology (Neurocritical Care and Emergency Neurology) (K.N.S.) and Neurosurgery (K.N.S.), Yale University, New Haven, CT. susanne.muehlschlegel@umassmemorial.org.
authors: Susanne
authors: S
authors: Muehlschlegel
authors: From the Departments of Neurology (Neurocritical Care) (S.M., A.A.), Surgery (S.M., D.A., T.E.), and Anesthesia/Critical Care (S.M.), University of Massachusetts Medical School, Worcester; Department of Neurology (Division of Neurocritical Care) (S.I.), Massachusetts General Hospital and Brigham & Women's Hospital, Harvard Medical School, Boston; Department of Surgery (T.M.S., D.M.S.), R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore; and Departments of Neurology (Neurocritical Care and Emergency Neurology) (K.N.S.) and Neurosurgery (K.N.S.), Yale University, New Haven, CT.
authors: Didem
authors: D
authors: Ayturk
authors: From the Departments of Neurology (Neurocritical Care) (S.M., A.A.), Surgery (S.M., D.A., T.E.), and Anesthesia/Critical Care (S.M.), University of Massachusetts Medical School, Worcester; Department of Neurology (Division of Neurocritical Care) (S.I.), Massachusetts General Hospital and Brigham & Women's Hospital, Harvard Medical School, Boston; Department of Surgery (T.M.S., D.M.S.), R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore; and Departments of Neurology (Neurocritical Care and Emergency Neurology) (K.N.S.) and Neurosurgery (K.N.S.), Yale University, New Haven, CT.
authors: Aditi
authors: A
authors: Ahlawat
authors: From the Departments of Neurology (Neurocritical Care) (S.M., A.A.), Surgery (S.M., D.A., T.E.), and Anesthesia/Critical Care (S.M.), University of Massachusetts Medical School, Worcester; Department of Neurology (Division of Neurocritical Care) (S.I.), Massachusetts General Hospital and Brigham & Women's Hospital, Harvard Medical School, Boston; Department of Surgery (T.M.S., D.M.S.), R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore; and Departments of Neurology (Neurocritical Care and Emergency Neurology) (K.N.S.) and Neurosurgery (K.N.S.), Yale University, New Haven, CT.
authors: Saef
authors: S
authors: Izzy
authors: From the Departments of Neurology (Neurocritical Care) (S.M., A.A.), Surgery (S.M., D.A., T.E.), and Anesthesia/Critical Care (S.M.), University of Massachusetts Medical School, Worcester; Department of Neurology (Division of Neurocritical Care) (S.I.), Massachusetts General Hospital and Brigham & Women's Hospital, Harvard Medical School, Boston; Department of Surgery (T.M.S., D.M.S.), R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore; and Departments of Neurology (Neurocritical Care and Emergency Neurology) (K.N.S.) and Neurosurgery (K.N.S.), Yale University, New Haven, CT.
authors: Thomas M
authors: TM
authors: Scalea
authors: From the Departments of Neurology (Neurocritical Care) (S.M., A.A.), Surgery (S.M., D.A., T.E.), and Anesthesia/Critical Care (S.M.), University of Massachusetts Medical School, Worcester; Department of Neurology (Division of Neurocritical Care) (S.I.), Massachusetts General Hospital and Brigham & Women's Hospital, Harvard Medical School, Boston; Department of Surgery (T.M.S., D.M.S.), R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore; and Departments of Neurology (Neurocritical Care and Emergency Neurology) (K.N.S.) and Neurosurgery (K.N.S.), Yale University, New Haven, CT.
authors: Deborah M
authors: DM
authors: Stein
authors: From the Departments of Neurology (Neurocritical Care) (S.M., A.A.), Surgery (S.M., D.A., T.E.), and Anesthesia/Critical Care (S.M.), University of Massachusetts Medical School, Worcester; Department of Neurology (Division of Neurocritical Care) (S.I.), Massachusetts General Hospital and Brigham & Women's Hospital, Harvard Medical School, Boston; Department of Surgery (T.M.S., D.M.S.), R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore; and Departments of Neurology (Neurocritical Care and Emergency Neurology) (K.N.S.) and Neurosurgery (K.N.S.), Yale University, New Haven, CT.
authors: Timothy
authors: T
authors: Emhoff
authors: From the Departments of Neurology (Neurocritical Care) (S.M., A.A.), Surgery (S.M., D.A., T.E.), and Anesthesia/Critical Care (S.M.), University of Massachusetts Medical School, Worcester; Department of Neurology (Division of Neurocritical Care) (S.I.), Massachusetts General Hospital and Brigham & Women's Hospital, Harvard Medical School, Boston; Department of Surgery (T.M.S., D.M.S.), R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore; and Departments of Neurology (Neurocritical Care and Emergency Neurology) (K.N.S.) and Neurosurgery (K.N.S.), Yale University, New Haven, CT.
authors: Kevin N
authors: KN
authors: Sheth
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging; D001930:Brain Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D005260:Female; D015600:Glasgow Coma Scale; D020197:Head Injuries, Penetrating / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010351:Patient Discharge; D011379:Prognosis; D012372:ROC Curve; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014481:United States