title: Predicted Unfavorable Neurologic Outcome Is Overestimated by the Marshall Computed Tomography Score, Corticosteroid Randomization After Significant Head Injury (CRASH), and International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) Models in Patients with Severe Traumatic Brain Injury Managed with Early Decompressive Craniectomy.
abstract: BACKGROUND
  Traumatic brain injury (TBI) is of public health interest and produces significant mortality and disability in Colombia. Calculators and prognostic models have been developed to establish neurologic outcomes. We tested prognostic models (the Marshall computed tomography [CT] score, International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT), and Corticosteroid Randomization After Significant Head Injury) for 14-day mortality, 6-month mortality, and 6-month outcome in patients with TBI at a university hospital in Colombia.
  
  
  METHODS
  A 127-patient cohort with TBI was treated in a regional trauma center in Colombia over 2 years and bivariate and multivariate analyses were used. Discriminatory power of the models, their accuracy, and precision was assessed by both logistic regression and area under the receiver operating characteristic curve (AUC). Shapiro-Wilk, χ2, and Wilcoxon test were used to compare real outcomes in the cohort against predicted outcomes.
  
  
  RESULTS
  The group's median age was 33 years, and 84.25% were male. The injury severity score median was 25, and median Glasgow Coma Scale motor score was 3. Six-month mortality was 29.13%. Six-month unfavorable outcome was 37%. Mortality prediction by Marshall CT score was 52.8%, P = 0.104 (AUC 0.585; 95% confidence interval [CI] 0 0.489-0.681), the mortality prediction by CRASH prognosis calculator was 59.9%, P < 0.001 (AUC 0.706; 95% CI 0.590-0.821), and the unfavorable outcome prediction by IMPACT was 77%, P < 0.048 (AUC 0.670; 95% CI 0.575-0.763).
  
  
  CONCLUSIONS
  In a university hospital in Colombia, the Marshall CT score, IMPACT, and Corticosteroid Randomization After Significant Head Injury models overestimated the adverse neurologic outcome in patients with severe head trauma.
authors.affiliation: Department of Medicine, Fundación Universitaria Navarra-Uninavarra, Neiva, Colombia; Universidad de Jaén, España. Electronic address: danielcharry06@gmail.com.
authors.forename: Jose D
authors.initials: JD
authors.lastname: Charry
authors.affiliation: Department of Anesthesiology and Resuscitation, Universidad Surcolombiana, Neiva, Colombia.
authors.forename: Jorman H
authors.initials: JH
authors.lastname: Tejada
authors.affiliation: Department of Anesthesiology and Resuscitation, Universidad Surcolombiana, Neiva, Colombia.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Pinzon
authors.affiliation: Department of Medicine, Universidad Surcolombiana, Neiva, Colombia.
authors.forename: Wilson A
authors.initials: WA
authors.lastname: Tejada
authors.affiliation: Department of Medicine, Universidad Surcolombiana, Neiva, Colombia.
authors.forename: Juan D
authors.initials: JD
authors.lastname: Ochoa
authors.affiliation: Department of Medicine, Universidad Surcolombiana, Neiva, Colombia.
authors.forename: Manuel
authors.initials: M
authors.lastname: Falla
authors.affiliation: Department of Anesthesiology and Resuscitation, Universidad Surcolombiana, Neiva, Colombia.
authors.forename: Jesus H
authors.initials: JH
authors.lastname: Tovar
authors.affiliation: Department of Medicine, Universidad Surcolombiana, Neiva, Colombia.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Cuellar-Bahamón
authors.affiliation: Department of Neurosurgery, Neiva University Hospital, Neiva, Colombia.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Solano
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D003105:Colombia / Q000453:epidemiology; D056424:Decompressive Craniectomy / Q000401:mortality / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011237:Predictive Value of Tests; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000401:mortality / Q000592:standards* / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Neurologic outcome; Prognosis models; Traumatic brain injury