Validation of prognostic models in intensive care unit–treated pediatric traumatic brain injury patients

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OBJECTIVE

There are few specific prognostic models specifically developed for the pediatric traumatic brain injury (TBI) population. In the present study, the authors tested the predictive performance of existing prognostic tools, originally developed for the adult TBI population, in pediatric TBI patients requiring stays in the ICU.

METHODS

The authors used the Finnish Intensive Care Consortium database to identify pediatric patients (< 18 years of age) treated in 4 academic ICUs in Finland between 2003 and 2013. They tested the predictive performance of 4 classification systems—the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) TBI model, the Helsinki CT score, the Rotterdam CT score, and the Marshall CT classification—by assessing the area under the receiver operating characteristic curve (AUC) and the explanatory variation (pseudo-R2 statistic). The primary outcome was 6-month functional outcome (favorable outcome defined as a Glasgow Outcome Scale score of 4–5).

RESULTS

Overall, 341 patients (median age 14 years) were included; of these, 291 patients had primary head CT scans available. The IMPACT core-based model showed an AUC of 0.85 (95% CI 0.78–0.91) and a pseudo-R2 value of 0.40. Of the CT scoring systems, the Helsinki CT score displayed the highest performance (AUC 0.84, 95% CI 0.78–0.90; pseudo-R2 0.39) followed by the Rotterdam CT score (AUC 0.80, 95% CI 0.73–0.86; pseudo-R2 0.34).

CONCLUSIONS

Prognostic tools originally developed for the adult TBI population seemed to perform well in pediatric TBI. Of the tested CT scoring systems, the Helsinki CT score yielded the highest predictive value.

ABBREVIATIONS AUC = area under the receiver operating characteristic curve; EHR = electronic healthcare record; FICC = Finnish Intensive Care Consortium; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; ICP = intracranial pressure; IVH = intraventricular hemorrhage; IMPACT = International Mission for Prognosis and Analysis of Clinical Trials; TBI = traumatic brain injury; TISS = Therapeutic Intervention Scoring System.

Supplementary Materials

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Article Information

Contributor Notes

Correspondence Era D. Mikkonen: Helsinki University Hospital & University of Helsinki, Helsinki, Finland. era.mikkonen@helsinki.fi.INCLUDE WHEN CITING Published online June 7, 2019; DOI: 10.3171/2019.4.PEDS1983.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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