Prognostic Models for Global Functional Outcome and Post-concussion Symptoms Following Mild Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (Center-TBI) Study

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aut.relation.endpage1670
aut.relation.issue15-16
aut.relation.journalJournal of Neurotrauma
aut.relation.startpage1651
aut.relation.volume40
dc.contributor.authorMikolić, A
dc.contributor.authorSteyerberg, EW
dc.contributor.authorPolinder, S
dc.contributor.authorWilson, L
dc.contributor.authorZeldovich, M
dc.contributor.authorvon Steinbueche, N
dc.contributor.authorNewcombe, VFJ
dc.contributor.authorMenon, DK
dc.contributor.authorvan der Naalt, J
dc.contributor.authorLingsma, HF
dc.contributor.authorMaas, AIR
dc.contributor.authorvan Klaveren, D
dc.contributor.authorÅkerlund, C
dc.contributor.authorAmrein, K
dc.contributor.authorAndelic, N
dc.contributor.authorAndreassen, L
dc.contributor.authorAnke, A
dc.contributor.authorAntoni, A
dc.contributor.authorAudibert, G
dc.contributor.authorAzouvi, P
dc.contributor.authorAzzolini, ML
dc.contributor.authorBartels, R
dc.contributor.authorBarzó, P
dc.contributor.authorBeauvais, R
dc.contributor.authorBeer, R
dc.contributor.authorBellander, BM
dc.contributor.authorBelli, A
dc.contributor.authorBenali, H
dc.contributor.authorBerardino, M
dc.contributor.authorBeretta, L
dc.contributor.authorBlaabjerg, M
dc.contributor.authorBragge, P
dc.contributor.authorBrazinova, A
dc.contributor.authorBrinck, V
dc.contributor.authorBrooker, J
dc.contributor.authorBrorsson, C
dc.contributor.authorBuki, A
dc.contributor.authorBullinger, M
dc.contributor.authorCabeleira, M
dc.contributor.authorCaccioppola, A
dc.contributor.authorCalappi, E
dc.contributor.authorCalvi, MR
dc.contributor.authorCameron, P
dc.contributor.authorCarbayo Lozano, G
dc.contributor.authorCarbonara, M
dc.contributor.authorCavallo, S
dc.contributor.authorChevallard, G
dc.contributor.authorChieregato, A
dc.contributor.authorCiterio, G
dc.contributor.authorClusmann, H
dc.contributor.authorCoburn, M
dc.contributor.authorColes, J
dc.contributor.authorCooper, JD
dc.contributor.authorCorreia, M
dc.contributor.authorČović, A
dc.contributor.authorCurry, N
dc.contributor.authorCzeiter, E
dc.contributor.authorCzosnyka, M
dc.contributor.authorFizelier, CD
dc.contributor.authorDark, P
dc.contributor.authorDawes, H
dc.contributor.authorDe Keyser, V
dc.contributor.authorDegos, V
dc.contributor.authorDella Corte, F
dc.contributor.authorden Boogert, H
dc.contributor.authorDepreitere, B
dc.contributor.authorÐilvesi, Ð
dc.contributor.authorDixit, A
dc.contributor.authorDonoghue, E
dc.contributor.authorDreier, J
dc.contributor.authorDulière, GL
dc.contributor.authorErcole, A
dc.contributor.authorEsser, P
dc.contributor.authorEzer, E
dc.contributor.authorFabricius, M
dc.contributor.authorFeigin, VL
dc.contributor.authorFoks, K
dc.contributor.authorFrisvold, S
dc.contributor.authorFurmanov, A
dc.contributor.authorGagliardo, P
dc.contributor.authorGalanaud, D
dc.contributor.authorGantner, D
dc.contributor.authorGao, G
dc.contributor.authorGeorge, P
dc.contributor.authorGhuysen, A
dc.contributor.authorGiga, L
dc.contributor.authorGlocker, B
dc.contributor.authorGolubovic, J
dc.contributor.authorGomez, PA
dc.contributor.authorGratz, J
dc.contributor.authorGravesteijn, B
dc.contributor.authorGrossi, F
dc.contributor.authorGruen, RL
dc.contributor.authorGupta, D
dc.contributor.authorHaagsma, JA
dc.contributor.authorHaitsma, I
dc.contributor.authorHelbok, R
dc.contributor.authorHelseth, E
dc.contributor.authorHorton, L
dc.contributor.authorHuijben, J
dc.date.accessioned2023-11-08T23:37:05Z
dc.date.available2023-11-08T23:37:05Z
dc.date.issued2023-08-16
dc.description.abstractAfter mild traumatic brain injury (mTBI), a substantial proportion of individuals do not fully recover on the Glasgow Outcome Scale Extended (GOSE) or experience persistent post-concussion symptoms (PPCS). We aimed to develop prognostic models for the GOSE and PPCS at 6 months after mTBI and to assess the prognostic value of different categories of predictors (clinical variables; questionnaires; computed tomography [CT]; blood biomarkers). From the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we included participants aged 16 or older with Glasgow Coma Score (GCS) 13-15. We used ordinal logistic regression to model the relationship between predictors and the GOSE, and linear regression to model the relationship between predictors and the Rivermead Post-concussion Symptoms Questionnaire (RPQ) total score. First, we studied a pre-specified Core model. Next, we extended the Core model with other clinical and sociodemographic variables available at presentation (Clinical model). The Clinical model was then extended with variables assessed before discharge from hospital: early post-concussion symptoms, CT variables, biomarkers, or all three categories (extended models). In a subset of patients mostly discharged home from the emergency department, the Clinical model was extended with 2-3–week post-concussion and mental health symptoms. Predictors were selected based on Akaike’s Information Criterion. Performance of ordinal models was expressed as a concordance index (C) and performance of linear models as proportion of variance explained (R2). Bootstrap validation was used to correct for optimism. We included 2376 mTBI patients with 6-month GOSE and 1605 patients with 6-month RPQ. The Core and Clinical models for GOSE showed moderate discrimination (C = 0.68 95% confidence interval 0.68 to 0.70 and C = 0.70[0.69 to 0.71], respectively) and injury severity was the strongest predictor. The extended models had better discriminative ability (C = 0.71[0.69 to 0.72] with early symptoms; 0.71[0.70 to 0.72] with CT variables or with blood biomarkers; 0.72[0.71 to 0.73] with all three categories). The performance of models for RPQ was modest (R2 = 4% Core; R2 = 9% Clinical), and extensions with early symptoms increased the R2 to 12%. The 2-3-week models had better performance for both outcomes in the subset of participants with these symptoms measured (C = 0.74 [0.71 to 0.78] vs. C = 0.63[0.61 to 0.67] for GOSE; R2 = 37% vs. 6% for RPQ). In conclusion, the models based on variables available before discharge have moderate performance for the prediction of GOSE and poor performance for the prediction of PPCS. Symptoms assessed at 2-3 weeks are required for better predictive ability of both outcomes. The performance of the proposed models should be examined in independent cohorts.
dc.identifier.citationJournal of Neurotrauma, ISSN: 0897-7151 (Print); 1557-9042 (Online), Mary Ann Liebert Inc, 40(15-16), 1651-1670. doi: 10.1089/neu.2022.0320
dc.identifier.doi10.1089/neu.2022.0320
dc.identifier.issn0897-7151
dc.identifier.issn1557-9042
dc.identifier.urihttp://hdl.handle.net/10292/16900
dc.languageeng
dc.publisherMary Ann Liebert Inc
dc.relation.urihttps://www.liebertpub.com/doi/10.1089/neu.2022.0320
dc.rights.accessrightsOpenAccess
dc.rights.urihttp://creativecommons.org/licenses/by/4.0
dc.subjectGlasgow Outcome Scale Extended
dc.subjectbiomarkers
dc.subjectmild traumatic brain injury
dc.subjectpost-concussion symptoms
dc.subjectpredictors
dc.subjectprognostic model
dc.subject5203 Clinical and Health Psychology
dc.subject52 Psychology
dc.subjectClinical Research
dc.subjectTraumatic Brain Injury (TBI)
dc.subjectTraumatic Head and Spine Injury
dc.subjectPhysical Injury - Accidents and Adverse Effects
dc.subjectNeurosciences
dc.subjectBrain Disorders
dc.subject3 Good Health and Well Being
dc.subject1103 Clinical Sciences
dc.subject1109 Neurosciences
dc.subjectNeurology & Neurosurgery
dc.subject3202 Clinical sciences
dc.subject3209 Neurosciences
dc.subject5202 Biological psychology
dc.subject.meshHumans
dc.subject.meshBrain Concussion
dc.subject.meshPost-Concussion Syndrome
dc.subject.meshPrognosis
dc.subject.meshBrain Injuries, Traumatic
dc.subject.meshBiomarkers
dc.subject.meshHumans
dc.subject.meshBrain Concussion
dc.subject.meshPost-Concussion Syndrome
dc.subject.meshPrognosis
dc.subject.meshBiomarkers
dc.subject.meshBrain Injuries, Traumatic
dc.subject.meshHumans
dc.subject.meshBrain Concussion
dc.subject.meshPost-Concussion Syndrome
dc.subject.meshPrognosis
dc.subject.meshBrain Injuries, Traumatic
dc.subject.meshBiomarkers
dc.titlePrognostic Models for Global Functional Outcome and Post-concussion Symptoms Following Mild Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (Center-TBI) Study
dc.typeJournal Article
pubs.elements-id527330
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