A protocol for the development of a prediction model in mild traumatic brain injury with CT scan abnormality: which patients are safe for discharge?
Abstract Background Head injury is an extremely common clinical presentation to hospital emergency departments (EDs). Ninety-five percent of patients present with an initial Glasgow Coma Scale (GCS) score of 13–15, indicating a normal or near-normal conscious level. In this group, around 7% of patie...
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| Format: | Article |
| Language: | English |
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BMC
2018-04-01
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| Series: | Diagnostic and Prognostic Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s41512-018-0027-4 |
| _version_ | 1818944602075299840 |
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| author | Carl Marincowitz Fiona E. Lecky William Townend Victoria Allgar Andrea Fabbri Trevor A. Sheldon |
| author_facet | Carl Marincowitz Fiona E. Lecky William Townend Victoria Allgar Andrea Fabbri Trevor A. Sheldon |
| author_sort | Carl Marincowitz |
| collection | DOAJ |
| description | Abstract Background Head injury is an extremely common clinical presentation to hospital emergency departments (EDs). Ninety-five percent of patients present with an initial Glasgow Coma Scale (GCS) score of 13–15, indicating a normal or near-normal conscious level. In this group, around 7% of patients have brain injuries identified by CT imaging but only 1% of patients have life-threatening brain injuries. It is unclear which brain injuries are clinically significant, so all patients with brain injuries identified by CT imaging are admitted for monitoring. If risk could be accurately determined in this group, admissions for low-risk patients could be avoided and resources could be focused on those with greater need. This study aims to (a) estimate the proportion of GCS13–15 patients with traumatic brain injury identified by CT imaging admitted to hospital who clinically deteriorate and (b) develop a prognostic model highly sensitive to clinical deterioration which could help inform discharge decision making in the ED. Methods A retrospective case note review of 2000 patients with an initial GCS13–15 and traumatic brain injury identified by CT imaging (2007–2017) will be completed in two English major trauma centres. The prevalence of clinically significant deterioration including death, neurosurgery, intubation, seizures or drop in GCS by more than 1 point will be estimated. Candidate prognostic factors have been identified in a previous systematic review. Multivariable logistic regression will be used to derive a prognostic model, and its sensitivity and specificity to the outcome of deterioration will be explored. Discussion This study will potentially derive a statistical model that predicts clinically relevant deterioration and could be used to develop a clinical risk tool guiding the need for hospital admission in this group. |
| first_indexed | 2024-12-20T07:45:49Z |
| format | Article |
| id | doaj.art-493b57fba4ec4c3388da3e0be98bb7ca |
| institution | Directory Open Access Journal |
| issn | 2397-7523 |
| language | English |
| last_indexed | 2024-12-20T07:45:49Z |
| publishDate | 2018-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Diagnostic and Prognostic Research |
| spelling | doaj.art-493b57fba4ec4c3388da3e0be98bb7ca2022-12-21T19:47:59ZengBMCDiagnostic and Prognostic Research2397-75232018-04-01211810.1186/s41512-018-0027-4A protocol for the development of a prediction model in mild traumatic brain injury with CT scan abnormality: which patients are safe for discharge?Carl Marincowitz0Fiona E. Lecky1William Townend2Victoria Allgar3Andrea Fabbri4Trevor A. Sheldon5Hull York Medical School, University of HullSchool of Health and Related Research, University of SheffieldEmergency Department, Hull and East Yorkshire NHS TrustHull York Medical School, University of YorkEmergency Unit, Presidio Ospedaliero Morgagni-Pierantoni, AUSL della RomagnaDepartment of Health Sciences, Alcuin Research Resource Centre, University of YorkAbstract Background Head injury is an extremely common clinical presentation to hospital emergency departments (EDs). Ninety-five percent of patients present with an initial Glasgow Coma Scale (GCS) score of 13–15, indicating a normal or near-normal conscious level. In this group, around 7% of patients have brain injuries identified by CT imaging but only 1% of patients have life-threatening brain injuries. It is unclear which brain injuries are clinically significant, so all patients with brain injuries identified by CT imaging are admitted for monitoring. If risk could be accurately determined in this group, admissions for low-risk patients could be avoided and resources could be focused on those with greater need. This study aims to (a) estimate the proportion of GCS13–15 patients with traumatic brain injury identified by CT imaging admitted to hospital who clinically deteriorate and (b) develop a prognostic model highly sensitive to clinical deterioration which could help inform discharge decision making in the ED. Methods A retrospective case note review of 2000 patients with an initial GCS13–15 and traumatic brain injury identified by CT imaging (2007–2017) will be completed in two English major trauma centres. The prevalence of clinically significant deterioration including death, neurosurgery, intubation, seizures or drop in GCS by more than 1 point will be estimated. Candidate prognostic factors have been identified in a previous systematic review. Multivariable logistic regression will be used to derive a prognostic model, and its sensitivity and specificity to the outcome of deterioration will be explored. Discussion This study will potentially derive a statistical model that predicts clinically relevant deterioration and could be used to develop a clinical risk tool guiding the need for hospital admission in this group.http://link.springer.com/article/10.1186/s41512-018-0027-4Mild traumatic brain injuryPrognosisPredictive modelIntra-cranial haemorrhageMinor head injury |
| spellingShingle | Carl Marincowitz Fiona E. Lecky William Townend Victoria Allgar Andrea Fabbri Trevor A. Sheldon A protocol for the development of a prediction model in mild traumatic brain injury with CT scan abnormality: which patients are safe for discharge? Diagnostic and Prognostic Research Mild traumatic brain injury Prognosis Predictive model Intra-cranial haemorrhage Minor head injury |
| title | A protocol for the development of a prediction model in mild traumatic brain injury with CT scan abnormality: which patients are safe for discharge? |
| title_full | A protocol for the development of a prediction model in mild traumatic brain injury with CT scan abnormality: which patients are safe for discharge? |
| title_fullStr | A protocol for the development of a prediction model in mild traumatic brain injury with CT scan abnormality: which patients are safe for discharge? |
| title_full_unstemmed | A protocol for the development of a prediction model in mild traumatic brain injury with CT scan abnormality: which patients are safe for discharge? |
| title_short | A protocol for the development of a prediction model in mild traumatic brain injury with CT scan abnormality: which patients are safe for discharge? |
| title_sort | protocol for the development of a prediction model in mild traumatic brain injury with ct scan abnormality which patients are safe for discharge |
| topic | Mild traumatic brain injury Prognosis Predictive model Intra-cranial haemorrhage Minor head injury |
| url | http://link.springer.com/article/10.1186/s41512-018-0027-4 |
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