The New Zealand medical journal · 2026
Comparison of two prognostic calculators predicting functional independence of patients with severe traumatic brain injury at discharge from rehabilitation services.
СтатьяНаблюдательное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Ravi Harini, Moosa Sheena, Soysa Ishani, Muthu Thirayan, Raunio Sami, Gan Peter, Young Tony, Christey Grant
Аннотация
AIM: This study evaluated functional outcomes months after severe traumatic brain injury (sTBI), and it compared the Corticosteroid Randomisation after Significant Head injury (CRASH) and International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) models.
METHODS: This was a retrospective observational cohort study using the Te Manawa Taki (TMT) trauma registry from 1 June 2012 to 31 December 2022. Seventy-nine sTBI patients who had CRASH and IMPACT parameters and Functional Independence Measure (FIM) scores were analysed. A Bland-Altman plot was used to compare the two prognostic calculators.
RESULTS: The FIM scores showed 10% severe, 33% moderate and 57% mild disability. Greater Glasgow Coma Scale (GCS) motor score of 1, hypoxia, hypotension, traumatic subarachnoid haemorrhage, petechial haemorrhage and non-evacuated haematoma rates were found in the TMT cohort. Bland-Altman analysis demonstrated good agreement (94.9%) between CRASH and IMPACT overall. The mean bias was -10.09 units, indicating that IMPACT systematically under-estimated CRASH, and hence they are not interchangeable.
CONCLUSION: This study highlights functional outcomes of the TMT sTBI cohort. CRASH and IMPACT were good in predicting functional outcome, but because of the systematic bias, we cannot compare the prediction outcome for a patient with CRASH against the prediction outcome of another patient with IMPACT.
METHODS: This was a retrospective observational cohort study using the Te Manawa Taki (TMT) trauma registry from 1 June 2012 to 31 December 2022. Seventy-nine sTBI patients who had CRASH and IMPACT parameters and Functional Independence Measure (FIM) scores were analysed. A Bland-Altman plot was used to compare the two prognostic calculators.
RESULTS: The FIM scores showed 10% severe, 33% moderate and 57% mild disability. Greater Glasgow Coma Scale (GCS) motor score of 1, hypoxia, hypotension, traumatic subarachnoid haemorrhage, petechial haemorrhage and non-evacuated haematoma rates were found in the TMT cohort. Bland-Altman analysis demonstrated good agreement (94.9%) between CRASH and IMPACT overall. The mean bias was -10.09 units, indicating that IMPACT systematically under-estimated CRASH, and hence they are not interchangeable.
CONCLUSION: This study highlights functional outcomes of the TMT sTBI cohort. CRASH and IMPACT were good in predicting functional outcome, but because of the systematic bias, we cannot compare the prediction outcome for a patient with CRASH against the prediction outcome of another patient with IMPACT.