Journal Reading

Prognostic model for patients with traumatic

brain injuries and abnormal CTscan

Presentant : dr Safridawati
Supervisor : DR. dr. Syahrul, Sp.S (K)
Kamis, 22 November 2017
PROGRAM PENDIDIKAN DOKTER SPESIALIS-I NEUROLOGI
FAKULTAS KEDOKTERAN UNIVERSITAS SYIAH KUALA
 1. INTRODUCTION

Traumatic brain injury (TBI) usually presents with a broad

spectrum of symptoms and disabilities
Creation of a prognostic model, with many variables, to stratify
the risk for an individual patient is a challenge aimed to develop
a prognostic model for assessment of survival chances after
TBI based on admission characteristics, including extracranial
injuries
The purpose of this model is to be applied before in-hospital
therapeutic interventions.
 2. METHODS

1275 px with TBI

Study Cohort and Abnormal
CT

Primary Final outcome on

Object mortality

Multivariate
Analysis logistic regression
Chi square
 RESULTS

General
characteristics

Extracranial
Multivariate
injuries and
analysis
mortality

GCS and Computed

anisocoria tomography
3. RESULTS
 DISCUSSION

• Predictors of mortality and 6 mounth outcome :

• GCS, Age, Pupillary reactivity
IMPACT

• with milder injuries (ECG > 12). In this study, the

variables associated with poor prognosis were: lower
GCS, older age, major extracranial injury and absent
CRASH pupil reactivity.

[16]
Maas AI, et al. Prognosis and clinical trial design intraumatic brain injury: the IMPACT study. J
Neurotrauma [19]
MRC Crash Trial Collaborators, et al. Predicting outcome after traumatic brain injury: practical
prognostic models based on large cohortof international patients. BMJ 2008;336(7641):425–9
 Extracranial Age
injury Ethnics

Anisocoria Gender Marshall

GCS
classification
 CONCLUSION

1. Estimation of prognosis is the keystone of neurological surgery.

2. In our study, age, presence of anisocoria, Marshall classification and GCS
were significantly related to poor outcome.
3. On the other hand, extracranial injuries demonstrated no relevant
influence on mortality in a multivariate model.
4. Mathematical probability model (USP Index) is a simple and effective
predictor of the mortality in patients with severe traumatic brain injury
and can be easily applied to the clinical decision-making process.
 CRITICAL APPRAISAL
ASPEK PROGNOSIS
I. Apakah Bukti Tentang Prognosis ini Valid Ya Tidak
1. Apakah terkumpul sebuah sampel pasien yang jelas dan refresentatif pada suatu √
titik (dini) dalam perjalanan penyakit?
2. Apakah Pengamatan Pasien cukup panjang dan Lengkap √
3. Apakah kriteria kesudahan yang objektiv diterapkan secara blind? √
4. Bila sekelompok dengan prognosis yang berbeda diidentifikasi :
- Apakah dilakukan penyesuaian (adjustmant) untuk faktor Prognosa yang penting? √
- Apakah dilakukan Validasi pada kelompok pasien test independen? √
II. Apakah Bukti Tentang Prognosis ini Penting

1. Seberapa Besar kemungkinan kesudahan ini terjadi untuk jangka waktu yang lebih
panjang ?
2. Seberapa persisi , estimasi kepercayaan (RK) prognosis?
III. Apakah kita dapat menerapkan Bukti Tentang Prognosis

1. Apakah Pasien dalam penelitian ini serupa dengan pasien kita ? √

2. Apakah bukti ini akan mempunyai pengaruh penting secara klinis terhadap √
kesimpulan kita tentang apa yang perlu ditawarkan atau diberitahukan terhadap
pasien kita?