Classification and regression trees (CART) for prediction of function at 1 year following head trauma

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✓ A cohort of 514 hospitalized head-injury survivors was identified based on their injury and 448 (87%) of them were followed for 1 year. Comprehensive neurobehavioral testing was performed 1 month and 1 year after injury.

The authors developed predictions of six neuropsychological and two psychosocial outcomes 1 year after head injury. Prediction trees are presented for verbal IQ, Halstead's Impairment Index, and work status at 1 year. Early predictors of neurobehavioral outcome in survivors are similar to previously reported predictors of mortality. Extent (both depth and length) of coma and age are the medical and demographic variables most predictive of late outcome. Adding 1-month scores substantially improves prediction of neuropsychological variables.

The classification and regression tree is a useful technique for predicting long-term outcome in patients with head injury. The trees are simple enough to be used in a clinical setting and, especially with 1-month scores, predictions are accurate enough for clinical utility.

Article Information

Address reprint requests to: Nancy R. Temkin, Ph.D., Department of Neurological Surgery (ZX-24), University of Washington, HMC, 325 9th Avenue, Seattle, Washington 98104.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Prediction tree depicting verbal intelligence quotient (IQ) at 1 year in 448 head-injury survivors. For each subgroup, the number of cases (n) and the mean (predicted) value are shown. GCS = Glasgow Coma Scale; EDUC = years of education; PUPILS = number of nonreactive pupils; CRANI = craniotomy category (1 = craniotomy for removal of a subdural or intracranial hematoma; 2 = craniotomy for removal of an epidural hematoma; 3 = craniotomy for both reasons; 4 = no craniotomy for these reasons); TFC = time to follow commands (duration of coma); VIQ = verbal IQ at 1 month.

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    Prediction tree demonstrating Impairment Index at 1 year. For each subgroup, the number of cases (n) and the mean (predicted) value are shown. (Patients who were too neurologically impaired to be tested at 1 year were assigned a value of 1.1; hence, some predicted values exceed 1.0). GCS = Glasgow Coma Scale; TFC = time to follow commands; (duration of coma); EDUC = years of education; II = Impairment Index at 1 month.

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    Prediction tree showing employment status at 1 year. For each subgroup, the number of cases (n) and the percent working at 1 year are shown. An individual is predicted to be working if the percent working in the appropriate subgroup is 50 or more. STABLE = stable employment preinjury; Glasgow Coma Scale; TFC = time to follow commands (duration of coma); WORK = working at 1 month postinjury.

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