Establishment and validation of prognosis model for patients with cerebral contusion

Factors affecting prognosis in traumatic cerebral contusions: A protocol for a systematic review and meta-analysis

BACKGROUND

Traumatic cerebral contusion (CC) is a severe type of injury among traumatic brain injury (TBI) patients. Individuals with traumatic CC typically exhibit rapid deterioration in their condition, leading to increased mortality rates. Despite this, there is a gap in evidence-based research. This study aims to identify the risk factors associated with adverse outcomes in patients with traumatic CC, with a particular focus on relevant biomarkers. Mortality will be the primary outcome, while the Glasgow Coma Scale (GCS) score will be considered as a secondary outcome.

METHODS AND ANALYSIS

We intend to conduct a comprehensive search through multiple Chinese and English repositories, covering the duration from the establishment of these databases up to the current era, in order to pinpoint appropriate studies. Additionally, a manual search of the references within the included literature and other pertinent works will be undertaken. The primary endpoint of this study will be the survival status of patients with traumatic brain contusion. Meta-analysis will be executed using STATA 16.0 (Stata Corporation, College Station, TX). Article selection and data extraction will be performed independently by two reviewers. The assessment of bias risks will be conducted via the Cochrane Collaboration's tool. Depending on the heterogeneity evaluation, either a fixed-effect model or a random-effects model will be applied. Subgroup and sensitivity analyses will be conducted as needed. The examination of publication bias will be carried out, and the quality of evidence for the primary outcomes will be graded. Trial registration number: CRD42023389456.

Development and validation of a clinical nomogram for predicting in-hospital mortality in patients with traumatic brain injury prehospital: A retrospective study

Objective

Traumatic brain injury (TBI) is among the leading causes of death and disability globally. Identifying and assessing the risk of in-hospital mortality in traumatic brain injury patients at an early stage is challenging. This study aimed to develop a model for predicting in-hospital mortality in TBI patients using prehospital data from China.

Methods

We retrospectively included traumatic brain injury patients who sustained injuries due to external forces and were treated by pre-hospital emergency medical services (EMS) at a tertiary hospital. Data from the pre-hospital emergency database were analyzed, including demographics, trauma mechanisms, comorbidities, vital signs, clinical symptoms, and trauma scores. Eligible patients were randomly divided into a training set (241 cases) and a validation set (104 cases) at a 7:3 ratio. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression were employed to identify independent risk factors. Analyzed the discrimination, calibration, and net benefit of the nomogram across both groups.

Results

17.40 % (42/241) of TBI patients died in the hospital in the training set, while 18.30 % (19/104) in the validation set. After analysis, chest trauma (odds ratio [OR] = 4.556, 95 % confidence interval [CI] = 1.861-11.152, P = 0.001), vomiting (OR = 2.944, 95%CI = 1.194-7.258, P = 0.019), systolic blood pressure (OR = 0.939, 95%CI = 0.913-0.966, P < 0.001), SpO2 (OR = 0.778, 95%CI = 0.688-0.881, P < 0.001), and heart rate (OR = 1.046, 95%CI = 1.015-1.078, P = 0.003) were identified as independent risk factors for in-hospital mortality in TBI patients. The nomogram based on the five factors demonstrated well-predictive power, with an area under the curve (AUC) of 0.881 in the training set and 0.866 in the validation set. The calibration curve and decision curve analysis showed that the predictive model exhibited good consistency and covered a wide range of threshold probabilities in both sets.

Conclusion

The nomogram based on prehospital data demonstrated well-predictive performance for in-hospital mortality in TBI patients, helping prehospital emergency physicians identify and assess severe TBI patients earlier, thereby improving the efficiency of prehospital emergency care.

The significance of admission blood lactate and fibrinogen in pediatric traumatic brain injury: a single-center clinical study

BACKGROUND

Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in pediatric patients, leading to long-term physical, cognitive, and psychological impairments. Blood lactate and fibrinogen levels have emerged as potential biomarkers associated with tissue hypoperfusion and coagulation dysfunction, respectively. However, limited research has specifically focused on the significance of these biomarkers in pediatric TBI. This study aimed to investigate the clinical significance of blood lactate and fibrinogen levels upon admission in pediatric patients with traumatic brain injury.

METHODS

The medical records of 80 children with a traumatic brain injury who were admitted from January 2017 to January 2021 were retrospectively analyzed. The two groups were compared according to whether the blood lactate in the admission arterial blood gas increased and the fibrinogen content in the coagulation function decreased. The clinical data of the children in the two groups were different, and then they were divided into a good prognosis group and a poor prognosis group according to the GOS prognostic score, and the differences in the clinical indicators of the two groups were compared.

RESULTS

Among the 80 patients, 33 had elevated blood lactate levels, 34 had decreased fibrinogen levels, and 29 had an unfavorable outcome (GOS < 4). Compared to the normal blood lactate group, there were no statistically significant differences in age, sex ratio, or platelet count in the elevated blood lactate group (P > 0.05). However, the elevated blood lactate group had lower Glasgow Coma Scale (GCS) scores upon admission, higher blood lactate levels, lower fibrinogen levels, longer hospital stay, lower GOS scores, and a higher proportion of GOS < 4 (P < 0.05). Compared to the normal fibrinogen group, there were no statistically significant differences in age, sex ratio, or platelet count in the decreased fibrinogen group (P > 0.05). However, the decreased fibrinogen group had lower GCS scores upon admission, higher blood lactate levels, lower fibrinogen levels, longer hospital stays, lower GOS scores, and a higher proportion of GOS < 4 (P < 0.05). Compared to the favorable outcome group, there were no statistically significant differences in age, sex ratio, or platelet count in the unfavorable outcome group (P > 0.05). However, the unfavorable outcome group had lower GCS scores upon admission, higher blood lactate levels, lower fibrinogen levels, longer hospital stays, a higher incidence of pulmonary infection, a higher incidence of stress ulcers, and lower GOS scores (P < 0.05).

CONCLUSION

The levels of blood lactate and fibrinogen may represent the severity of children with traumatic brain injury and may be risk factors for poor prognosis of children with traumatic brain injury.

An analysis of neutrophil-to-lymphocyte ratios and monocyte-to-lymphocyte ratios with six-month prognosis after cerebral contusions

Background and purpose

Neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) have been identified as potential prognostic markers in various conditions, including cancer, cardiovascular disease, and stroke. This study aims to investigate the dynamic changes of NLR and MLR following cerebral contusion and their associations with six-month outcomes.

Methods

Retrospective data were collected from January 2016 to April 2020, including patients diagnosed with cerebral contusion and discharged from two teaching-oriented tertiary hospitals in Southern China. Patient demographics, clinical manifestations, laboratory test results (neutrophil, monocyte, and lymphocyte counts) obtained at admission, 24 hours, and one week after cerebral contusion, as well as outcomes, were analyzed. An unfavorable outcome was defined as a Glasgow Outcome Score (GOS) of 0-3 at six months. Logistic regression analysis was performed to identify independent predictors of prognosis, while receiver characteristic curve analysis was used to determine the optimal cutoff values for NLR and MLR.

Results

A total of 552 patients (mean age 47.40, SD 17.09) were included, with 73.19% being male. Higher NLR at one-week post-cerebral contusion (adjusted OR = 4.19, 95%CI, 1.16 - 15.16, P = 0.029) and higher MLR at admission and at 24 h (5.80, 1.40 - 24.02, P = 0.015; 9.06, 1.45 - 56.54, P = 0.018, respectively) were significantly associated with a 6-month unfavorable prognosis after adjustment for other risk factors by multiple logistic regression. The NLR at admission and 24 hours, as well as the MLR at one week, were not significant predictors for a 6-month unfavorable prognosis. Based on receiver operating characteristic curve analysis, the optimal thresholds of NLR at 1 week and MLR at admission after cerebral contusion that best discriminated a unfavorable outcome at 6-month were 6.39 (81.60% sensitivity and 70.73% specificity) and 0.76 (55.47% sensitivity and 78.26% specificity), respectively.

Conclusion

NLR measured one week after cerebral contusion and MLR measured at admission may serve as predictive markers for a 6-month unfavorable prognosis. These ratios hold potential as parameters for risk stratification in patients with cerebral contusion, complementing established biomarkers in diagnosis and treatment. However, further prospective studies with larger cohorts are needed to validate these findings.

Predictors of radiological contusion progression in traumatic brain injury

BACKGROUND

Traumatic brain injury, mainly caused by the unintentional falls and motor vehicle accidents, is a serious condition encompassing a spectrum of pathological features from axonal to hemorrhagic injuries. Among these, cerebral contusions significantly contribute to death and disability following the injury and occur in up to 35% of cases. This study aimed to investigate the predictors of radiological contusion progression in traumatic brain injury.

METHODS

We performed a retrospective cross-sectional study using the files of the patients with mild traumatic brain injury who had cerebral contusions from 21 March 2021 to 20 March 2022. The severity of brain injury was determined using the Glasgow Coma Score. Furthermore, we used a cut-off value of a 30% increase in contusion size in the secondary CT scans (up to 72 hours) compared to the first one to define the significant progression of the contusions. For the patients with multiple contusions, we measured the biggest contusion.

RESULTS

705 patients with traumatic brain injury were found, the severity of the injury was mild in 498 of them, and 218 had cerebral contusions. 131 (60.1%) patients were injured in vehicle accidents. 111 (50.9%) had significant contusion progression. Most patients were conservatively managed, but 21 out of them (10%) required delayed surgical intervention.

CONCLUSION

We found that the presence of subdural hematoma, subarachnoid hemorrhage, and epidural hematoma were predictors of radiological contusion progression, and the patients with a subdural hematoma and epidural hematoma were more likely to undergo surgery. In addition to providing prognostic information, predicting risk factors for the progression of the contusions is crucial for identifying patients who might benefit from surgical and critical care therapies.