Prediction of Persistent Post-Concussion Symptoms after Mild Traumatic Brain Injury
Prediction of Persistent Post-Concussion Symptoms after Mild Traumatic Brain Injury
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DOI：
10.1089/neu.2017.5486
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发表时间：
2018-07-23
影响因子：
4.2
通讯作者：
Lingsma, Hester F.
中科院分区：
文献类型：
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作者：
Cnossen, Maryse C.;van der Naalt, Joukje;Lingsma, Hester F.
持续性脑震荡后症状（PPCS）经常发生在轻度创伤性脑损伤（mTBI）后。由于缺乏有效的预测模型，识别具有不良结局风险的患者仍然具有挑战性。本研究的目的是评估PPCS预测模型的质量和临床价值，并根据现有模型的综合和急诊科（艾德）的投诉，开发一种新的模型。在UPFRONT研究中，从2013年至2015年期间的三个荷兰I级创伤中心前瞻性招募了mTBI患者（格拉斯哥昏迷量表评分13-15）。在伤后6个月使用头部损伤严重程度检查表评估PPCS。检查了两个预测模型（Stulemeijer 2008; Cnossen 2017）的校准和区分。最终的模型包括现有模型的变量，增加了头痛，恶心/呕吐，颈部疼痛在艾德，使用logistic回归和bootstrap验证。现有模型在外部验证中表现不佳（曲线下面积[AUC]：0.57-0.64）。新开发的模型包括女性性别（比值比[OR] 1.48，95%置信区间[CI] [1.01-2.18]），颈部疼痛（OR 2.58，[1.39-4.78]），脑震荡后2周症状（OR 4.89，[3.19-7.49]）和两周创伤后应激（OR 2.98，[1.88-4.73]）作为显著预测因素。该模型的区分度足够（bootstrap验证后的AUC：0.75）。PPCS的现有预测模型表现不佳。一个新的模型合理地执行预测因素已经在艾德识别进一步的外部验证。应通过标准化定义和数据收集以及使用合理的方法来改进mTBI的预测研究。
Persistent post-concussion symptoms (PPCS) occur frequently after mild traumatic brain injury (mTBI). The identification of patients at risk for poor outcome remains challenging because valid prediction models are missing. The objectives of the current study were to assess the quality and clinical value of prediction models for PPCS and to develop a new model based on the synthesis of existing models and addition of complaints at the emergency department (ED). Patients with mTBI (Glasgow Coma Scale score 13-15) were recruited prospectively from three Dutch level I trauma centers between 2013 and 2015 in the UPFRONT study. PPCS were assessed using the Head Injury Severity Checklist at six months post-injury. Two prediction models (Stulemeijer 2008; Cnossen 2017) were examined for calibration and discrimination. The final model comprised variables of existing models with the addition of headache, nausea/vomiting, and neck pain at ED, using logistic regression and bootstrap validation.Overall, 591 patients (mean age 51years, 41% female) were included; PPCS developed in 241 (41%). Existing models performed poorly at external validation (area under the curve [AUC]: 0.57-0.64). The newly developed model included female sex (odds ratio [OR] 1.48, 95% confidence interval [CI] [1.01-2.18]), neck pain (OR 2.58, [1.39-4.78]), two-week post-concussion symptoms (OR 4.89, [3.19-7.49]) and two-week post-traumatic stress (OR 2.98, [1.88-4.73]) as significant predictors. Discrimination of this model was adequate (AUC after bootstrap validation: 0.75). Existing prediction models for PPCS perform poorly. A new model performs reasonably with predictive factors already discernible at ED warranting further external validation. Prediction research in mTBI should be improved by standardizing definitions and data collection and by using sound methodology.