Prognostic Value of IMPACT and CRASH Models in the Assessment of Patients with Traumatic Brain Injury: a Comparative Study

Abstract

Background International Mission on Prognosis and Analysis of Clinical Trial (IMPACT) and Corticosteroid Randomisation after Significant Head Injury (CRASH) are internationally influential prognostic models for traumatic brain injury (TBI), which need to be continuously developed, improved and continuously verified externally to ensure generalizability to different settings. Objective To verify and compare the prognostic evaluation values of IMPACT and CRASH simultaneously in TBI population in China. Methods A total of 210 TBI patients treated in Zhengzhou Central Hospital Affiliated to Zhengzhou University from 2017 to 2019 were retrospectively selected as the study objects, and the basic information of the included patients was collected. The 14-day survival and 6-month Glasgow prognostic score (GOS) of the patients were followed up until June 2021, with a termination event of loss of follow-up. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive efficacy of IMPACT and CRASH models in TBI patients, and the area under ROC curve (AUC) was calculated. Brier score was used to evaluate the calibration degree of the model. Results The average age of the patients was (54.0±17.4) years. The ROC curves of the IMPACT model and CRASH model to predict the prognosis of TBI patients were plotted, respectively, and the results showed that the AUCs of IMPACT core model, CT model and laboratory model to predict the poor prognosis of GOS in TBI patients at 6 months was 0.807 (95%CI=0.747-0.866, P<0.001), 0.843 (95%CI=0.789-0.897, P<0.001), 0.845 (95%CI=0.793-0.897, P<0.001), Brier scores were 0.179, 0.164, 0.161, respectively; the AUCs of IMPACT core model, CT model and laboratory model predicting 6-month death in TBI patients were 0.868 (95%CI=0.816-0.919, P<0.001), 0.896 (95%CI=0.851-0.941, P<0.001), 0.892 (95%CI=0.850-0.935, P<0.001), and Brier scores were 0.151, 0.144 and 0.136, respectively. The AUCs of CRASH basic model and CT model to predict the poor prognosis of GOS in TBI patients at 6 months was 0.747 (95%CI=0.682-0.813, P<0.001) and 0.766 (95%CI=0.703-0.829, P<0.001) ; Brier scores were 0.306 and 0.308, respectively. The AUCs of CRASH basic model and CT model for predicting 14-day death of TBI patients were 0.791 (95%CI=0.723-0.860, P<0.001) and 0.797 (95%CI=0.728-0.865, P<0.001), the Brier scores were 0.348 and 0.383, respectively. Conclusion For the prognosis of TBI patients, the IMPACT model showed better overall predictive capacity than the CRASH model.

Keywords

• wounds and injuries|craniocerebral trauma|impact|crash|risk prediction model