Abstract:
:For patients surviving serious traumatic brain injury (TBI), families and other stakeholders often desire information on long-term functional prognosis, but accurate and easy-to-use clinical tools are lacking. We aimed to build utilitarian decision trees from commonly collected clinical variables to predict Glasgow Outcome Scale (GOS) functional levels at 1, 2, and 5 years after moderate-to-severe closed TBI. Flexible classification tree statistical modeling was used on prospectively collected data from the TBI-Model Systems (TBIMS) inception cohort study. Enrollments occurred at 17 designated, or previously designated, TBIMS inpatient rehabilitation facilities. Analysis included all participants with nonpenetrating TBI injured between January 1997 and January 2017. Sample sizes were 10,125 (year-1), 8,821 (year-2), and 6,165 (year-5) after cross-sectional exclusions (death, vegetative state, insufficient post-injury time, and unavailable outcome). In our final models, post-traumatic amnesia (PTA) duration consistently dominated branching hierarchy and was the lone injury characteristic significantly contributing to GOS predictability. Lower-order variables that added predictability were age, pre-morbid education, productivity, and occupational category. Generally, patient outcomes improved with shorter PTA, younger age, greater pre-morbid productivity, and higher pre-morbid vocational or educational achievement. Across all prognostic groups, the best and worst good recovery rates were 65.7% and 10.9%, respectively, and the best and worst severe disability rates were 3.9% and 64.1%. Predictability in test data sets ranged from C-statistic of 0.691 (year-1; confidence interval [CI], 0.675, 0.711) to 0.731 (year-2; CI, 0.724, 0.738). In conclusion, we developed a clinically useful tool to provide prognostic information on long-term functional outcomes for adult survivors of moderate and severe closed TBI. Predictive accuracy for GOS level was demonstrated in an independent test sample. Length of PTA, a clinical marker of injury severity, was by far the most critical outcome determinant.
journal_name
J Neurotraumajournal_title
Journal of neurotraumaauthors
Walker WC,Stromberg KA,Marwitz JH,Sima AP,Agyemang AA,Graham KM,Harrison-Felix C,Hoffman JM,Brown AW,Kreutzer JS,Merchant Rdoi
10.1089/neu.2017.5359subject
Has Abstractpub_date
2018-07-15 00:00:00pages
1587-1595issue
14eissn
0897-7151issn
1557-9042journal_volume
35pub_type
杂志文章abstract::Growing evidence suggests that temporally proximal acute concussions and repetitive subconcussive head injuries may lead to long-term neurological deficits. However, the underlying mechanisms of injury and their relative time-scales are not well documented in human injury models. The current study therefore investigat...
journal_title:Journal of neurotrauma
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abstract::Increasing evidence indicates that post-traumatic stress disorder (PTSD) may develop following traumatic brain injury (TBI), despite most patients having no conscious memory of their accident. This prospective study examined the frequency, timing of onset, symptom profile, and trajectory of PTSD and its psychiatric co...
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abstract::Previous meta-analyses of methylprednisolone (MPS) for patients with acute traumatic spinal cord injuries (TSCIs) have not addressed confidence in the quality of evidence used for pooled effect estimates, and new primary studies have been recently published. We aimed to determine whether MPS improves motor recovery an...
journal_title:Journal of neurotrauma
pub_type: 杂志文章,meta分析,评审
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journal_title:Journal of neurotrauma
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journal_title:Journal of neurotrauma
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journal_title:Journal of neurotrauma
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更新日期:2010-10-01 00:00:00
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journal_title:Journal of neurotrauma
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
doi:10.1089/neu.2006.23.1632
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
doi:10.1089/neu.2011.1989
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journal_title:Journal of neurotrauma
pub_type: 杂志文章,评审
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journal_title:Journal of neurotrauma
pub_type: 杂志文章,评审
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journal_title:Journal of neurotrauma
pub_type: 杂志文章,评审
doi:
更新日期:1992-03-01 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
doi:10.1089/neu.2013.2978
更新日期:2014-07-01 00:00:00
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journal_title:Journal of neurotrauma
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doi:10.1089/neu.2018.5975
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
doi:10.1089/neu.2016.4464
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abstract::Traumatic brain injury (TBI) is a leading cause of death and functional disability in western countries, affecting mostly young patients. Despite intense and sustained efforts deployed for the development of new therapeutic strategies, no clinical benefit has been shown by any of the investigated compounds. Increasing...
journal_title:Journal of neurotrauma
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doi:10.1089/neu.2008-0856
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
doi:10.1089/neu.1997.14.885
更新日期:1997-12-01 00:00:00
abstract::Persistent post-traumatic headache (PPTH) is often the most common injury after mild traumatic brain injury (mTBI), reported by 47-95% of patients. Progressive muscle relaxation (PMR) has level A evidence in preventing migraine and tension headaches. However, research on this behavioral therapy for PPTH, let alone sma...
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pub_type: 杂志文章
doi:10.1089/neu.2019.6601
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
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更新日期:2014-02-15 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
doi:10.1089/neu.1994.11.255
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journal_title:Journal of neurotrauma
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journal_title:Journal of neurotrauma
pub_type: 杂志文章,评审
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