Perel, Pablo Andraes;
(2009)
Prognosis in traumatic brain injury.
PhD thesis, London School of Hygiene & Tropical Medicine.
DOI: https://doi.org/10.17037/PUBS.01635515
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Introduction:
The
general
purpose
of
this
thesis
was
to
study
prognosis
in
traumatic
brain
injury
(TBI)
patients,
with
the
aim
of
providing
useful
and
practical
information
in
clinical
practice
and
clinical
research.
The
specific
objectives
were:
to
develop
and
validate
practical
prognostic
models
for
TBI
patients
and
to
assess
the
validity
of
the
Modified
Oxford
Handicap
Scale
(mOHS)
for
predicting
disability
at
six
months.
Methods:
A
survey
was
first
conducted
to
understand
the
importance
of
prognostic
information
among
physicians.
A
systematic
review
of
prognostic
models
for
TBI
patients
was
then
carried
out.
Prognostic
models
were
developed
using
data
from
a
cohort
of
10,008
TBI
patients
(CRASH
trial)
and
validated
in
a
cohort
of
8,509
TBI
patients
(IMPACT
study).
Two
focus
groups
and
a
survey
were
conducted
to
develop
a
paper-based
prognostic
score
card.
The
correlation
between
the
mOHS
and
the
Glasgow
Outcome
Scale
(GOS)
was
assessed,
the
validity
of
different
mOHS
dichotomies
was
assessed,
and
the
discriminative
ability
of
the
mOHS
to
predict
GOS
was
evaluated.
Results:
Doctors
considered
prognostic
information
to
be
very important
in
the
clinical
management
of
TBI
patients,
and
believed
that
an
accurate
prognostic
model
would
change
their
current
clinical
practice.
Many
prognostic
models
for
TBI
have
been
published,
but
they
have
many
methodological
flaws
which
limit
their
validity.
Valid
prognostic
models
for
patients
from
high
income
countries
and
low
&
middle
income
.countries
were
developed
and
made
available
as
a
web
calculator,
and
as
a
paper
based
score
card.
The
mOHS
was
strongly
correlated
with
and
was
predictive
of
GOS
at
six
months.
Conclusion:
The
prognostic
models
developed
are
valid
and
practical
to
use
in
the
clinical
setting.
The
association
between
mOHS
and
GOS
suggest
that
the
mOHS
could
be
used
for
interim
analysis
in
randomised
clinical
trials
in
TBI
patients,
for
dealing
with
loss
to
follow-up,
or
could
be
used
as
simple
tool
to
inform
patients
and
relatives
about
their
prognosis
at
hospital
discharge