Neuroanesthesia & neurocritical care
Secondary Neurologic Deterioration After Moderate Traumatic Brain Injury: Development of a Multivariable Prediction Model and Proposition of a Simple Triage Score
Authors' conclusion
In this study, we demonstrate that moTBI patients have a significant risk of SND. A simple weighted score at hospital admission could be able to detect patients at risk of SND.
Study context
- Population
- Adults admitted to an academic trauma center for moderate TBI (GCS 9–13), January 2016 to January 2019
- Participants
- 142 adults
- Outcome
- Secondary neurologic deterioration (SND): GCS decrease >2 points from admission without sedation, or neurologic deterioration requiring intervention (mechanical ventilation, sedation, osmotherapy, intensive care unit (ICU) transfer or neurosurgery)
- Follow-up
- First week
Methodological detailssingle-centre, logistic regression, bootstrap internal validation
- Single-centre
- Logistic regression
- Bootstrap internal validation
Main finding
As reported in the abstract
SND incidence and independent predictors
Odds ratio (95% CI)P value
Age above 60 years
3.45(1.45–8.48)
P = 0.005Brain frontal contusion
3.22(1.31–8.49)
P = 0.01Prehospital or admission arterial hypotension
4.86(2.03–12.60)
P = 0.006Marshall CT score of 6
3.25(1.31–8.20)
P = 0.01- Patients with secondary neurologic deterioration (SND)
- 46 (32%)
Observational data: associations, not effects.
Further findings
14-day mortality
- 14-day mortality rate
- 18.4%
SND score (range 0-10: age >60 y 3 points, hypotension 3, frontal contusion 2, Marshall computed tomography (CT) 6 2) discrimination
- AUC
- 0.73 (95% CI, 0.65-0.82)
SND score of 3 to predict SND
- Sensitivity
- 85%
- Specificity
- 50%
- NPV
- 87%
- PPV
- 44 %
Original publication
Secondary Neurologic Deterioration After Moderate Traumatic Brain Injury: Development of a Multivariable Prediction Model and Proposition of a Simple Triage Score. Anesth Analg. Published 25 April 2023. doi:10.
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