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dc.contributor.authorBhattacharyay, Shubhayuen_UK
dc.contributor.authorMilosevic, Ioanen_UK
dc.contributor.authorWilson, Lindsayen_UK
dc.contributor.authorMenon, David Ken_UK
dc.contributor.authorStevens, Robert Den_UK
dc.contributor.authorSteyerberg, Ewout Wen_UK
dc.contributor.authorNelson, David Wen_UK
dc.contributor.authorErcole, Arien_UK
dc.description.abstractWhen a patient is admitted to the intensive care unit (ICU) after a traumatic brain injury (TBI), an early prognosis is essential for baseline risk adjustment and shared decision making. TBI outcomes are commonly categorised by the Glasgow Outcome Scale–Extended (GOSE) into eight, ordered levels of functional recovery at 6 months after injury. Existing ICU prognostic models predict binary outcomes at a certain threshold of GOSE (e.g., prediction of survival [GOSE > 1]). We aimed to develop ordinal prediction models that concurrently predict probabilities of each GOSE score. From a prospective cohort (n = 1,550, 65 centres) in the ICU stratum of the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) patient dataset, we extracted all clinical information within 24 hours of ICU admission (1,151 predictors) and 6-month GOSE scores. We analysed the effect of two design elements on ordinal model performance: (1) the baseline predictor set, ranging from a concise set of ten validated predictors to a token-embedded representation of all possible predictors, and (2) the modelling strategy, from ordinal logistic regression to multinomial deep learning. With repeated k-fold cross-validation, we found that expanding the baseline predictor set significantly improved ordinal prediction performance while increasing analytical complexity did not. Half of these gains could be achieved with the addition of eight high-impact predictors to the concise set. At best, ordinal models achieved 0.76 (95% CI: 0.74–0.77) ordinal discrimination ability (ordinal c-index) and 57% (95% CI: 54%– 60%) explanation of ordinal variation in 6-month GOSE (Somers’ Dxy). Model performance and the effect of expanding the predictor set decreased at higher GOSE thresholds, indicating the difficulty of predicting better functional outcomes shortly after ICU admission. Our results motivate the search for informative predictors that improve confidence in prognosis of higher GOSE and the development of ordinal dynamic prediction models.en_UK
dc.publisherPublic Library of Scienceen_UK
dc.relationBhattacharyay S, Milosevic I, Wilson L, Menon DK, Stevens RD, Steyerberg EW, Nelson DW & Ercole A (2022) The leap to ordinal: Detailed functional prognosis after traumatic brain injury with a flexible modelling approach. PLoS ONE, 17 (7), Art. No.: e0270973.
dc.rights© 2022 Bhattacharyay et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_UK
dc.titleThe leap to ordinal: Detailed functional prognosis after traumatic brain injury with a flexible modelling approachen_UK
dc.typeJournal Articleen_UK
dc.citation.jtitlePLoS ONEen_UK
dc.type.statusVoR - Version of Recorden_UK
dc.contributor.funderNational Institute for Health Researchen_UK
dc.contributor.affiliationUniversity of Cambridgeen_UK
dc.contributor.affiliationUniversity of Cambridgeen_UK
dc.contributor.affiliationUniversity of Cambridgeen_UK
dc.contributor.affiliationJohns Hopkins Universityen_UK
dc.contributor.affiliationLeiden University Medical Centeren_UK
dc.contributor.affiliationKarolinska Instituteten_UK
dc.contributor.affiliationUniversity of Cambridgeen_UK
rioxxterms.apcnot requireden_UK
rioxxterms.typeJournal Article/Reviewen_UK
local.rioxx.authorBhattacharyay, Shubhayu|en_UK
local.rioxx.authorMilosevic, Ioan|en_UK
local.rioxx.authorWilson, Lindsay|0000-0003-4113-2328en_UK
local.rioxx.authorMenon, David K|en_UK
local.rioxx.authorStevens, Robert D|en_UK
local.rioxx.authorSteyerberg, Ewout W|en_UK
local.rioxx.authorNelson, David W|en_UK
local.rioxx.authorErcole, Ari|en_UK
local.rioxx.projectProject ID unknown|National Institute for Health Research|
Appears in Collections:Psychology Journal Articles

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