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Updated: Jan 23, 2026
A Novel In Vitro Model of Blast Traumatic Brain Injury
Published on: December 21, 2018
Validation of prognostic models in intensive care unit-treated pediatric traumatic brain injury patients
Era D Mikkonen1, Markus B Skrifvars2, Matti Reinikainen3
11Department of Anesthesiology, Intensive Care and Pain Medicine, and Department of Emergency Care and Services, Helsinki University Hospital, and University of Helsinki.
Insights
Adult traumatic brain injury (TBI) prognostic models show promise in pediatric TBI patients. The Helsinki CT score demonstrated the highest predictive value among tested systems for pediatric TBI outcomes.
Area of Science:
- Neuroscience
- Pediatric Critical Care
- Trauma Surgery
Background:
- Pediatric traumatic brain injury (TBI) lacks specific prognostic models.
- Existing adult TBI prognostic tools require validation in pediatric populations.
Purpose of the Study:
- To evaluate the predictive performance of established adult TBI prognostic models in pediatric ICU patients.
- To identify the most effective CT-based scoring systems for predicting outcomes in pediatric TBI.
Main Methods:
- Utilized Finnish Intensive Care Consortium data (2003-2013) for pediatric (<18 years) ICU patients.
- Assessed International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) TBI model, Helsinki CT score, Rotterdam CT score, and Marshall CT classification.
- Evaluated predictive performance using area under the receiver operating characteristic curve (AUC) and pseudo-R2.
Main Results:
- The IMPACT core-based model achieved an AUC of 0.85 (95% CI 0.78-0.91).
- The Helsinki CT score showed the highest performance among CT systems (AUC 0.84, 95% CI 0.78-0.90).
- Rotterdam CT score also demonstrated good predictive value (AUC 0.80, 95% CI 0.73-0.86).
Conclusions:
- Adult TBI prognostic models appear effective for pediatric TBI cases.
- The Helsinki CT score offers the highest predictive accuracy for pediatric TBI outcomes among the evaluated CT scoring systems.
Objective:
There are few specific prognostic models specifically developed for the pediatric traumatic brain injury (TBI) population. In the present study, the authors tested the predictive performance of existing prognostic tools, originally developed for the adult TBI population, in pediatric TBI patients requiring stays in the ICU.
Methods:
The authors used the Finnish Intensive Care Consortium database to identify pediatric patients (< 18 years of age) treated in 4 academic ICUs in Finland between 2003 and 2013. They tested the predictive performance of 4 classification systems-the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) TBI model, the Helsinki CT score, the Rotterdam CT score, and the Marshall CT classification-by assessing the area under the receiver operating characteristic curve (AUC) and the explanatory variation (pseudo-R2 statistic). The primary outcome was 6-month functional outcome (favorable outcome defined as a Glasgow Outcome Scale score of 4-5).
Results:
Overall, 341 patients (median age 14 years) were included; of these, 291 patients had primary head CT scans available. The IMPACT core-based model showed an AUC of 0.85 (95% CI 0.78-0.91) and a pseudo-R2 value of 0.40. Of the CT scoring systems, the Helsinki CT score displayed the highest performance (AUC 0.84, 95% CI 0.78-0.90; pseudo-R2 0.39) followed by the Rotterdam CT score (AUC 0.80, 95% CI 0.73-0.86; pseudo-R2 0.34).
Conclusions:
Prognostic tools originally developed for the adult TBI population seemed to perform well in pediatric TBI. Of the tested CT scoring systems, the Helsinki CT score yielded the highest predictive value.
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