Morris et al reported models for predicting outcomes after traumatic brain injury at different time periods after the injury. The authors are from the Medical College of Wisconsin, University of Washington Seattle, Brigham and Women's Hospital, University of Minnesota and North Memorial Health Hospital.
Patient selection: traumatic brain injury, age 26 years or older
Outcome: Quality of Life after Brain Injury Overall Scale (QOLIBRI-OS)
Time frame: 12 months after traumatic brain injury
Parameters:
(1) time from injury to admission, presumably hours
(2) age in years
(3) race
(4) systolic blood pressure in mm Hg, lowest on day 0
(5) number of reactive pupils from 0 to 2, lowest number on day 0
(6) serum sodium in mmol/L, highest on day 0
(7) serum potassium in mmol/L, lowest on day 0
(8) serum creatinine in mg/dL, highest on day 0
(9) blood urea in mmol/L, highest on day 0
(10) hematocrit in percent, lowest on day 0
(11) platelet count in 10^9/L, highest on day 0
(12) PTT in seconds, on day 0
(13) cerebral edema on initial head CT
(14) past history of hypertension
(15) past history of neurologic disorder
(16) past history of psychiatric disorder
(17) past history of gastrointestinal disease
(18) past history of endocrine disorder
(19) smoker
(20) pre-injury anticoagulant use
(21) insurance
Parameter |
Finding |
Points |
time from injury to admission |
|
-0.040 * (time) |
age in years |
< 45 years |
0 |
|
45 to 54 years |
-0.289 |
|
55 to 64 years |
-0.763 |
|
65 to 74 years |
-0.402 |
|
>= 75 years |
-0.577 |
race |
Black |
-0.560 |
|
other |
0.660 |
systolic blood pressure |
|
0.008 * (SBP) |
number of reactive pupils |
|
0.561 * (number) |
aPTT |
|
-0.024 * (aPTT) |
serum sodium in mmol/L |
|
-0.030 * (sodium) |
serum potassium |
|
0.364 * (potassium) |
serum creatinine |
|
-0.412 * (creatinine) |
urea in mmol/L |
|
0.027 * (urea) |
hematocrit |
|
0.00002 * (hematocrit) |
platelet count |
|
-0.002 * (platelet) |
cerebral edema on initial CT |
no |
0 |
|
yes |
-0.844 |
hypertension |
no |
0 |
|
yes |
-0.663 |
neurologic |
no |
0 |
|
yes |
-0.625 |
psychiatric |
no |
0 |
|
yes |
-0.692 |
gastrointestinal |
no |
0 |
|
yes |
-0.502 |
endocrine |
no |
0 |
|
yes |
-0.4743.989
|
smoker |
no |
0 |
|
yes |
-0.610 |
pre-injury anticoagulant |
no |
0 |
|
yes |
0.240 |
insurance |
medicaid or similar |
-0.842 |
|
medicare or similar |
-0.255 |
|
private |
0 |
where:
• The units for the laboratory results are not given in the paper. The units for creatinine, urea, and platelet count are guesses. In the US BUN in mg/dL is more common than mmol/L.
value of X =
= SUM(points for all of the parameters) + 3.989
risk of favorable QOLIBRI at 12 months after the injury =
= 1 / ( 1 +EXP((-1) * X))
Performance:
• The area under the ROC curve was 0.81.
Specialty: Surgery, orthopedic, Emergency Medicine