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Bai X, Wang R, Zhang C, Wen D, Ma L, He M. The prognostic value of an age-adjusted BIG score in adult patients with traumatic brain injury. Front Neurol 2023; 14:1272994. [PMID: 38020644 PMCID: PMC10656741 DOI: 10.3389/fneur.2023.1272994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background The base deficit, international normalized ratio, and Glasgow Coma Scale (BIG) score was previously developed to predict the outcomes of pediatric trauma patients. We designed this study to explore and improve the prognostic value of the BIG score in adult patients with traumatic brain injury (TBI). Methods Adult patients diagnosed with TBI in a public critical care database were included in this observational study. The BIG score was calculated based on the Glasgow Coma Scale (GCS), the international normalized ratio (INR), and the base deficit. Logistic regression analysis was performed to confirm the association between the BIG score and the outcome of included patients. Receiver operating characteristic (ROC) curves were drawn to evaluate the prognostic value of the BIG score and novel constructed models. Results In total, 1,034 TBI patients were included in this study with a mortality of 22.8%. Non-survivors had higher BIG scores than survivors (p < 0.001). The results of multivariable logistic regression analysis showed that age (p < 0.001), pulse oxygen saturation (SpO2) (p = 0.032), glucose (p = 0.015), hemoglobin (p = 0.047), BIG score (p < 0.001), subarachnoid hemorrhage (p = 0.013), and intracerebral hematoma (p = 0.001) were associated with in-hospital mortality of included patients. The AUC (area under the ROC curves) of the BIG score was 0.669, which was not as high as in previous pediatric trauma cohorts. However, combining the BIG score with age increased the AUC to 0.764. The prognostic model composed of significant factors including BIG had the highest AUC of 0.786. Conclusion The age-adjusted BIG score is superior to the original BIG score in predicting mortality of adult TBI patients. The prognostic model incorporating the BIG score is beneficial for clinicians, aiding them in making early triage and treatment decisions in adult TBI patients.
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Affiliation(s)
- Xue Bai
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Cuomaoji Zhang
- Department of Anesthesiology, Affiliated Sport Hospital of Chengdu Sport University, Chengdu, Sichuan, China
| | - Dingke Wen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Abbas Q, Zeeshan A, Jawwad M, Moazzam M, Yousafzai M. BIG score and its comparison with different scoring systems for mortality prediction in children with severe traumatic brain injury admitted in pediatric intensive care unit. J Pediatr Neurosci 2023. [DOI: 10.4103/jpn.jpn_16_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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The authors reply. Pediatr Crit Care Med 2022; 23:e301-e302. [PMID: 35703782 DOI: 10.1097/pcc.0000000000002938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bharuchi V, Rasheed MA. Development and feasibility testing of the mental status examination scale to assess functional status of young, hospitalized children in Pakistan. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Daley M, Cameron S, Ganesan SL, Patel MA, Stewart TC, Miller MR, Alharfi I, Fraser DD. Pediatric severe traumatic brain injury mortality prediction determined with machine learning-based modeling. Injury 2022; 53:992-998. [PMID: 35034778 DOI: 10.1016/j.injury.2022.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/02/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Severe traumatic brain injury (sTBI) is a leading cause of mortality in children. As clinical prognostication is important in guiding optimal care and decision making, our goal was to create a highly discriminative sTBI outcome prediction model for mortality. METHODS Machine learning and advanced analytics were applied to the patient admission variables obtained from a comprehensive pediatric sTBI database. Demographic and clinical data, head CT imaging abnormalities and blood biochemical data from 196 children and adolescents admitted to a tertiary pediatric intensive care unit (PICU) with sTBI were integrated using feature ranking by way of a forest of randomized decision trees, and a model was generated from a reduced number of admission variables with maximal ability to discriminate outcome. RESULTS In total, 36 admission variables were analyzed using feature ranking with variable weighting to determine their predictive importance for mortality following sTBI. Reduction analysis utilizing Borata feature selection resulted in a parsimonious six-variable model with a mortality classification accuracy of 82%. The final admission variables that predicted mortality were: partial thromboplastin time (22%); motor Glasgow Coma Scale (21%); serum glucose (16%); fixed pupil(s) (16%); platelet count (13%) and creatinine (12%). Using only these six admission variables, a t-distributed stochastic nearest neighbor embedding algorithm plot demonstrated visual separation of sTBI patients that lived or died, with high mortality predictive ability of this model on the validation dataset (AUC = 0.90) which was confirmed with a conventional area-under-the-curve statistical approach on the total dataset (AUC = 0.91; P < 0.001). CONCLUSIONS Machine learning-based modeling identified the most clinically important prognostic factors resulting in a pragmatic, high performing prognostic tool for pediatric sTBI with excellent discriminative ability to predict mortality risk with 82% classification accuracy (AUC = 0.90). After external multicenter validation, our prognostic model might help to guide treatment decisions, aggressiveness of therapy and prepare family members and caregivers for timely end-of-life discussions and decision making. LEVEL OF EVIDENCE III; Prognostic.
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Affiliation(s)
- Mark Daley
- Computer Science, Western University, London, ON N6A 3K7, Canada; The Vector Institute for Artificial Intelligence, Toronto, ON M5G 1M1, Canada.
| | - Saoirse Cameron
- Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada.
| | - Saptharishi Lalgudi Ganesan
- Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada.
| | - Maitray A Patel
- Computer Science, Western University, London, ON N6A 3K7, Canada.
| | - Tanya Charyk Stewart
- Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada; Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada.
| | - Michael R Miller
- Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada.
| | - Ibrahim Alharfi
- Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Douglas D Fraser
- Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada; Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada; Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada; NeuroLytix Inc., Toronto, ON M5E 1J8, Canada.
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Enomoto Y, Tsutsumi Y, Tsuchiya A, Kido T, Ishigami K, Togo M, Yasuda S, Inoue Y. Validation of the Japan Coma Scale for the prediction of mortality in children: analysis of a nationwide trauma database. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000350. [DOI: 10.1136/wjps-2021-000350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 12/10/2021] [Indexed: 11/04/2022] Open
Abstract
ObjectiveThe Japan Coma Scale (JCS) is widely used in clinical practice to evaluate levels of consciousness in Japan. There have been several studies on the usefulness of JCS in adults. However, its usefulness in evaluating children has not been reported. Therefore, this study aimed to assess the usefulness of the JCS for the prediction of mortality in children.MethodsThis is a multicenter cohort study which used data from a national trauma registry (Japan Trauma Data Bank). This study included patients under 16 years of age who were treated between 2004 and 2015.The primary outcome measure was in-hospital mortality. Two models were used to examine each item of the Glasgow Coma Scale (GCS) and the JCS. Model A included the discrete levels of each index. In model B, data regarding age, sex, vital signs on arrival to hospital, the Injury Severity Score, and blunt trauma were added to each index. The effectivity of the JCS score was then evaluated using the area under the curve (AUC) for discrimination, a calibration plot, and the Hosmer-Lemeshow test for calibration.ResultsA total of 9045 patients were identified. The AUCs of the GCS and JCS were 0.929 (95% confidence interval (CI) 0.904 to 0.954) and 0.930 (95% CI 0.906 to 0.954) in model A and 0.975 (95% CI 0.963 to 0.987) and 0.974 (95% CI 0.963 to 0.985) in model B, respectively. The results of the Hosmer-Lemeshow test were 0.00 (p=1.00) and 0.00 (p=1.00) in model A and 4.14 (p=0.84) and 8.55 (p=0.38) in model B for the GCS and JCS, respectively.ConclusionsWe demonstrated that the JCS is as valid as the GCS for predicting mortality. The findings of this study indicate that the JCS is a useful and relevant tool for pediatric trauma care and future research.
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Abeytunge K, Miller MR, Cameron S, Stewart TC, Alharfi I, Fraser DD, Tijssen JA. Development of a Mortality Prediction Tool in Pediatric Severe Traumatic Brain Injury. Neurotrauma Rep 2021; 2:115-122. [PMID: 34223549 PMCID: PMC8240826 DOI: 10.1089/neur.2020.0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Severe traumatic brain injury (sTBI) is a leading cause of pediatric death, yet outcomes remain difficult to predict. The goal of this study was to develop a predictive mortality tool in pediatric sTBI. We retrospectively analyzed 196 patients with sTBI (pre-sedation Glasgow Coma Scale [GCS] score <8 and head Maximum Abbreviated Injury Scale (MAIS) score >4) admitted to a pediatric intensive care unit (PICU). Overall, 56 patients with sTBI (29%) died during PICU stay. Of the survivors, 88 (63%) were discharged home, and 52 (37%) went to an acute care or rehabilitation facility. Receiver operating characteristic (ROC) curve analyses of admission variables showed that pre-sedation GCS score, Rotterdam computed tomography (CT) score, and partial thromboplastin time (PTT) were fair predictors of PICU mortality (area under the curve [AUC] = 0.79, 0.76, and 0.75, respectively; p < 0.001). Cutoff values best associated with PICU mortality were pre-sedation GCS score <5 (sensitivity = 0.91, specificity = 0.54), Rotterdam CT score >3 (sensitivity = 0.84, specificity = 0.53), and PTT >34.5 sec (sensitivity = 0.69 specificity = 0.67). Combining pre-sedation GCS score, Rotterdam CT score, and PTT in ROC curve analysis yielded an excellent predictor of PICU mortality (AUC = 0.91). In summary, pre-sedation GCS score (<5), Rotterdam CT score (>3), and PTT (>34.5 sec) obtained on hospital admission were fair predictors of PICU mortality, ranked highest to lowest. Combining these three admission variables resulted in an excellent pediatric sTBI mortality prediction tool for further prospective validation.
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Affiliation(s)
- Kawmadi Abeytunge
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Michael R Miller
- Department of Paediatrics, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Saoirse Cameron
- Department of Paediatrics, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | | | - Ibrahim Alharfi
- Department of Pediatric Critical Care, Children's Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Douglas D Fraser
- Department of Paediatrics, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada.,Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Janice A Tijssen
- Department of Paediatrics, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada
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Getting the Right Score for Pediatric Traumatic Brain Injury-Is BIG a Help? Pediatr Crit Care Med 2019; 20:996-997. [PMID: 31580278 DOI: 10.1097/pcc.0000000000002063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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