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Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
Published on: May 27, 2022
Development of a nomogram to predict the outcome of moderate or severe pediatric traumatic brain injury
Thakul Oearsakul1, Thara Tunthanathip1
1Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Insights
This study developed a nomogram to predict outcomes for children with moderate or severe traumatic brain injury (TBI). The tool demonstrated excellent predictive performance for 6-month follow-up outcomes in pediatric TBI patients.
Area of Science:
- Pediatric Neurology
- Neurotraumatology
- Clinical Prediction Modeling
Background:
- Traumatic brain injury (TBI) is a leading cause of death and disability in children in Thailand, with significant economic impact.
- Accurate prediction of long-term outcomes is crucial for managing pediatric TBI.
Purpose of the Study:
- To develop and internally validate a nomogram for predicting 6-month follow-up outcomes in pediatric patients with moderate or severe TBI.
- To identify key clinical predictors associated with functional outcomes after TBI in children.
Main Methods:
- A retrospective cohort study of 104 children with moderate or severe TBI.
- Functional outcomes were assessed using the King's Outcome Scale for Childhood Head Injury at discharge and 6-month follow-up.
- Multivariable binary logistic regression was used to develop a predictive model and nomogram, with internal validation via bootstrapping and cross-validation.
Main Results:
- Road traffic accidents were the primary cause of TBI in 84.6% of cases.
- Significant predictors for poor 6-month outcome included Glasgow Coma Scale scores of 3-8, pupillary abnormalities, hypotension, and subarachnoid hemorrhage.
- The nomogram achieved a high discrimination index (C-index) of 0.931, with validated C-indices of 0.920 and 0.924.
Conclusions:
- The developed clinical nomogram shows excellent performance in predicting 6-month outcomes for pediatric TBI.
- Further external validation is necessary to confirm the reliability and generalizability of this predictive tool.
Objectives:
Traumatic brain injury (TBI) in children has become the major cause of mortality and morbidity in Thailand that has had an impact with economic consequences. This study aimed to develop and internally validate a nomogram for a 6-month follow-up outcome prediction in moderate or severe pediatric TBI.
Methods:
This retrospective cohort study involved 104 children with moderate or severe TBI. Various clinical variables were reviewed. The functional outcome was assessed at the hospital discharge and at a 6-month follow-up based on the King's Outcome Scale for Childhood Head Injury classification. Predictors associated with the 6-month follow-up outcome were developed from the predictive model using multivariable binary logistic regression to estimate the performance and internal validation. A nomogram was developed and presented as a predictive model.
Results:
The mean age of the samples was 99.75 months (standard deviation 59.65). Road traffic accidents were the highest injury mechanism at 84.6%. The predictive model comprised Glasgow Coma Scale of 3-8 (odds ratio [OR]: 16.07; 95% confidence interval [CI]: 1.27-202.42), pupillary response in one eye (OR 7.74; 95% CI 1.26-47.29), pupillary nonresponse in both eyes (OR: 57.74; 95% CI: 2.28-145.81), hypotension (OR: 19.54; 95%: CI 3.23-117.96), and subarachnoid hemorrhage (OR: 9.01, 95% CI: 1.33-60.80). The concordance statistic index (C-index) of the model's discrimination was 0.931, while the C-index following the bootstrapping and 5-cross validation were 0.920 and 0.924, respectively.
Conclusions:
The performance of a clinical nomogram for predicting 6-month follow-up outcomes in pediatric TBI patients was assessed at an excellent level. However, further external validation would be required for the confirmation of the tool's performance.
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