Prediction of Global Functional Outcome and Post-Concussive Symptoms after Mild Traumatic Brain Injury: External Validation of Prognostic Models in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study

Abstract

The majority of patients with traumatic brain injury (TBI) are categorized as mild according to a baseline Glasgow Coma Scale (GCS) score of 13 to 15. Prognostic models that were developed to predict functional outcome and persistent post-concussive symptoms (PPCS) after mild TBI have rarely been externally validated. We aimed to identify validate existing models predicting 3 to 12-month Glasgow Outcome Scale Extended (GOSE) or PPCS in adults with mild TBI. We analyzed data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) project, which included 2862 adults with mild TBI, with 6-month GOSE available for 2374, and the Rivermead Post-concussion Symptom Questionnaire (RPQ) for 1605 participants. Model performance was evaluated based on calibration (graphically and characterized by slope and intercept) and discrimination (c-index). We validated five published models for 6-month GOSE and three for 6-month PPCS scores. The models used different cutoffs for outcome and some included symptoms measured 2 weeks post-injury. Discriminative ability varied substantially (C- index between 0.58 and 0.79). The models developed in the CRASH trial for prediction of GOSE