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Published on: September 16, 2022
Development and internal validation of a nomogram for predicting outcomes in children with traumatic subdural
Anukoon Kaewborisutsakul1, Thara Tunthanathip1
1Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Insights
This study developed a nomogram to predict outcomes in children with subdural hematoma (SDH) after traumatic brain injury (TBI). The tool identified key predictors of poor outcomes, aiding clinical decision-making for pediatric TBI patients.
Area of Science:
- Pediatric neurosurgery
- Clinical prediction modeling
- Traumatic brain injury research
Background:
- Subdural hematoma (SDH) following traumatic brain injury (TBI) in children can result in severe disability or death.
- Clinical prediction tools, such as nomograms, are vital for physicians to advise parents on treatment decisions.
- This study aimed to develop and validate a nomogram for predicting outcomes in pediatric SDH cases.
Purpose of the Study:
- To develop a predictive model (nomogram) for outcomes in children with SDH post-TBI.
- To identify significant predictors associated with unfavorable outcomes in this patient group.
- To provide a tool for improved prognosis and clinical decision-making.
Main Methods:
- Retrospective analysis of 103 children with SDH after TBI.
- Functional outcomes assessed at hospital discharge using the King's Outcome Scale for Childhood Head Injury.
- Binary logistic regression used to identify predictors of unfavorable outcomes; a nomogram was subsequently developed.
Main Results:
- Key predictors of unfavorable outcomes included hypotension, Glasgow Coma Scale scores of 3-8, and fixed pupils.
- Midline shift ≥5 mm and co-existing intraventricular hemorrhage were also identified as significant factors.
- The developed predictive model demonstrated a high level of predictability.
Conclusions:
- SDH in pediatric TBI is associated with significant mortality and disability risks.
- The developed nomogram shows excellent predictability for outcomes in pediatric TBI with SDH.
- External validation is recommended to confirm the clinical utility of this prediction tool.
Background:
A subdural hematoma (SDH) following a traumatic brain injury (TBI) in children can lead to unexpected death or disability. The nomogram is a clinical prediction tool used by physicians to provide prognosis advice to parents for making decisions regarding treatment. In the present study, a nomogram for predicting outcomes was developed and validated. In addition, the predictors associated with outcomes in children with traumatic SDH were determined.
Methods:
In this retrospective study, 103 children with SDH after TBI were evaluated. According to the King's Outcome Scale for Childhood Head Injury classification, the functional outcomes were assessed at hospital discharge and categorized into favorable and unfavorable. The predictors associated with the unfavorable outcomes were analyzed using binary logistic regression. Subsequently, a two-dimensional nomogram was developed for presentation of the predictive model.
Results:
The predictive model with the lowest level of Akaike information criterion consisted of hypotension (odds ratio [OR], 9.4; 95% confidence interval [CI], 2.0-42.9), Glasgow coma scale scores of 3-8 (OR, 8.2; 95% CI, 1.7-38.9), fixed pupil in one eye (OR, 4.8; 95% CI, 2.6-8.8), and fixed pupils in both eyes (OR, 3.5; 95% CI, 1.6-7.1). A midline shift ≥5 mm (OR, 1.1; 95% CI, 0.62-10.73) and co-existing intraventricular hemorrhage (OR, 6.5; 95% CI, 0.003-26.1) were also included.
Conclusions:
SDH in pediatric TBI can lead to mortality and disability. The predictability level of the nomogram in the present study was excellent, and external validation should be conducted to confirm the performance of the clinical prediction tool.
