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Accuracy of Early Neuroprognostication in Pediatric Severe Traumatic Brain Injury
Varun Sampat1, John Whitinger1, Katherine Flynn-O'Brien2
1Division of Pediatric Neurology, Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Insights
Clinicians inaccurately predicted worse outcomes for children with severe traumatic brain injury (sTBI). Most patients achieved good functional recovery, indicating a need to refine neuroprognostication methods for pediatric TBI survivors.
Area of Science:
- Pediatric Neurology
- Neurotraumatology
- Clinical Outcomes Research
Background:
- Children with severe traumatic brain injury (sTBI) face significant risks of long-term functional deficits.
- Accurate neuroprognostication is crucial for guiding clinical decisions and managing patient care after sTBI.
- This study evaluated the accuracy of clinician predictions for functional outcomes in pediatric sTBI survivors.
Purpose of the Study:
- To assess the accuracy of clinician-predicted functional outcomes in children with sTBI.
- To compare predicted functional status scores with actual outcomes at 3-6 months post-injury.
- To identify factors influencing the accuracy of neuroprognostication in this population.
Main Methods:
- Clinicians predicted functional outcomes using the Functional Status Scale (FSS) for pediatric sTBI patients.
- Predictions were compared to actual FSS scores at 3-6 months post-injury.
- Agreement was assessed using Lin concordance correlation coefficients; outcomes were dichotomized as good or poor.
Main Results:
- Clinicians' predicted FSS scores (mean 10.8) were significantly higher than actual scores (mean 8.6), indicating overestimation of poor outcomes.
- A majority of patients (15/24) achieved complete or near-complete recovery (FSS 6-7).
- Eight children received a pessimistic prognostic prediction, overestimating their functional deficit.
Conclusions:
- Clinicians tend to predict worse functional outcomes than what is ultimately achieved in pediatric sTBI survivors.
- The high rate of good recovery suggests current neuroprognostication may be overly cautious.
- Further research in larger cohorts is needed to understand patient and provider factors affecting prognostic accuracy.
Background:
Children with severe traumatic brain injury (sTBI) are at risk for neurological sequelae impacting function. Clinicians are tasked with neuroprognostication to assist in decision-making. We describe a single-center study assessing clinicians' neuroprognostication accuracy.
Methods:
Clinicians of various specialties caring for children with sTBI were asked to predict their patients' functioning three to six months postinjury. Clinicians were asked to participate in the study if their patient had survived but not returned to baseline between day 4 and 7 postinjury. The outcome tool utilized was the functional status scale (FSS), ranging from 6 to 30 (best-worst function). Predicted scores were compared with actual scores three to six months postinjury. Lin concordance correlation coefficients were used to estimate agreement between predicted and actual FSS. Outcome was dichotomized as good (FSS 6 to 8) or poor (FSS ≥9). Positive and negative predictive values for poor outcome were calculated. Pessimistic prognostic prediction was defined as predicted worse outcome by ≥3 FSS points. Demographic and clinical variables were collected.
Results:
A total of 107 surveys were collected on 24 patients. Two children died. Fifteen children had complete (FSS = 6) or near-complete (FSS = 7) recovery. Mean predicted and actual FSS scores were 10.8 (S.D. 5.6) and 8.6 (S.D. 4.1), respectively. Predicted FSS scores were higher than actual scores (P < 0.001). Eight children had collective pessimistic prognostic prediction.
Conclusions:
Clinicians predicted worse functional outcomes, despite high percentage of patients with near-normal function at follow-up clinic. Certain patient and provider factors were noted to impact accuracy and need to be studied in larger cohorts.
