Title
A systematic review finds methodological improvements necessary for prognostic models in determining traumatic brain injury outcomes
Date Issued
01 April 2008
Access level
metadata only access
Resource Type
review
Author(s)
Mushkudiani N.A.
Hukkelhoven C.W.P.M.
Murray G.D.
Choi S.C.
Maas A.I.R.
Steyerberg E.W.
Erasmus University Medical Center
Abstract
Objectives: To describe the modeling techniques used for early prediction of outcome in traumatic brain injury (TBI) and to identify aspects for potential improvements. Study Design and Setting: We reviewed key methodological aspects of studies published between 1970 and 2005 that proposed a prognostic model for the Glasgow Outcome Scale of TBI based on admission data. Results: We included 31 papers. Twenty-four were single-center studies, and 22 reported on fewer than 500 patients. The median of the number of initially considered predictors was eight, and on average five of these were selected for the prognostic model, generally including age, Glasgow Coma Score (or only motor score), and pupillary reactivity. The most common statistical technique was logistic regression with stepwise selection of predictors. Model performance was often quantified by accuracy rate rather than by more appropriate measures such as the area under the receiver-operating characteristic curve. Model validity was addressed in 15 studies, but mostly used a simple split-sample approach, and external validation was performed in only four studies. Conclusion: Although most models agree on the three most important predictors, many were developed on small sample sizes within single centers and hence lack generalizability. Modeling strategies have to be improved, and include external validation. © 2008 Elsevier Inc. All rights reserved.
Start page
331
End page
343
Volume
61
Issue
4
Language
English
OCDE Knowledge area
Estadísticas, Probabilidad
Neurología clínica
Interdisciplinariedad
Subjects
Scopus EID
2-s2.0-39649107553
PubMed ID
Source
Journal of Clinical Epidemiology
ISSN of the container
08954356
Sponsor(s)
The authors wish to thank Marja van Gemerden and Frans Slieker for administrative assistance and support. Grant support was provided by NIH NS 42691.
Sources of information:
Directorio de Producción Científica
Scopus