Clinical elements that predict outcome after traumatic brain injury: A prospective multicenter recursive partitioning (decision-tree) analysis
Clinical elements that predict outcome after traumatic brain injury: A prospective multicenter recursive partitioning (decision-tree) analysis
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DOI：
10.1089/neu.2005.22.1040
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发表时间：
2005-10-01
影响因子：
4.2
通讯作者：
Cifu, DX
中科院分区：
文献类型：
--
作者：
Brown, AW;Malec, JF;Cifu, DX
创伤性脑损伤（TBI）通常会给临床医生带来复杂的临床因素组合，这些因素可能会混淆治疗并使结果预测具有挑战性。预测模型通常使用急性生理变量和大体临床指标来预测死亡率和基本结局终点。本研究的主要目标是考虑有关入院接受住院康复的TBI幸存者的所有可用临床因素，并确定预测残疾、监督需求和受伤一年后生产活动的因素。使用创伤性脑损伤模型系统（TBIMS）数据库进行决策树分析，使用递归分区（n = 3463）。结果测量包括功能独立性测量（TM），残疾评定量表，监督评定量表，和生产活动的措施。预测变量包括所有体格检查要素、损伤严重程度的测量（初始格拉斯哥昏迷量表评分、创伤后遗忘症[PTA]持续时间、昏迷时间、CT扫描病理学）、性别、年龄和受教育年限。PTA的持续时间、年龄和体格检查的大多数因素都是早期残疾的预测因素。选择单独PTA的持续时间来预测晚期残疾和独立生活。PTA的持续时间，年龄，坐姿平衡和肢体力量被选为预测生产活动在1年。PTA的持续时间是该模型中选择的所有终点结局的最佳预测因子，体格检查的元素提供了额外的预测值。有效和可靠的PTA和TBI后的身体损害的措施是非常重要的准确的结果预测。
Traumatic brain injury (TBI) often presents clinicians with a complex combination of clinical elements that can confound treatment and make outcome prediction challenging. Predictive models have commonly used acute physiological variables and gross clinical measures to predict mortality and basic outcome endpoints. The primary goal of this study was to consider all clinical elements available concerning a survivor of TBI admitted for inpatient rehabilitation, and identify those factors that predict disability, need for supervision, and productive activity one year after injury. The Traumatic Brain Injury Model Systems (TBIMS) database was used for decision tree analysis using recursive partitioning (n = 3463). Outcome measures included the Functional Independence Measure(TM), the Disability Rating Scale, the Supervision Rating Scale, and a measure of productive activity. Predictor variables included all physical examination elements, measures of injury severity (initial Glasgow Coma Scale score, duration of post-traumatic amnesia [PTA], length of coma, CT scan pathology), gender, age, and years of education. The duration of PTA, age, and most elements of the physical examination were predictive of early disability. The duration of PTA alone was selected to predict late disability and independent living. The duration of PTA, age, sitting balance, and limb strength were selected to predict productive activity at 1 year. The duration of PTA was the best predictor of outcome selected in this model for all endpoints and elements of the physical examination provided additional predictive value. Valid and reliable measures of PTA and physical impairment after TBI are important for accurate outcome prediction.