التفاصيل البيبلوغرافية
| العنوان: |
Development and external validation of the KIIDS‐TBI tool for managing children with mild traumatic brain injury and intracranial injuries. |
| المؤلفون: |
Greenberg, Jacob K., Ahluwalia, Ranbir, Hill, Madelyn, Johnson, Gabbie, Hale, Andrew T., Belal, Ahmed, Baygani, Shawyon, Olsen, Margaret A., Foraker, Randi E., Carpenter, Christopher R., Yan, Yan, Ackerman, Laurie, Noje, Corina, Jackson, Eric, Burns, Erin, Sayama, Christina M., Selden, Nathan R., Vachhrajani, Shobhan, Shannon, Chevis N., Kuppermann, Nathan |
| المصدر: |
Academic Emergency Medicine; Dec2021, Vol. 28 Issue 12, p1409-1420, 12p |
| مصطلحات موضوعية: |
EXPERIMENTAL design, RESEARCH methodology, RESEARCH methodology evaluation, SEVERITY of illness index, RISK assessment, DESCRIPTIVE statistics, BRAIN injuries, STATISTICAL models, DECISION making in clinical medicine, DISEASE risk factors, CHILDREN |
| مستخلص: |
Background: Clinical decision support (CDS) may improve the postneuroimaging management of children with mild traumatic brain injuries (mTBI) and intracranial injuries. While the CHIIDA score has been proposed for this purpose, a more sensitive risk model may have broader use. Consequently, this study's objectives were to: (1) develop a new risk model with improved sensitivity compared to the CHIIDA model and (2) externally validate the new model and CHIIDA model in a multicenter data set. Methods: We analyzed children ≤18 years old with mTBI and intracranial injuries included in the PECARN head injury data set (2004–2006). We used binary recursive partitioning to predict the composite outcome of neurosurgical intervention, intubation for > 24 h due to TBI, or death due to TBI. The new model was externally validated in a separate data set that included children treated at any one of six centers from 2006 to 2019. Results: Based on 839 patients from the PECARN data set, a new risk model, the KIIDS‐TBI model, was developed that incorporated imaging (e.g., midline shift) and clinical (e.g., Glasgow Coma Scale score) findings. Based on the model‐predicted probability of the composite outcome, three cutoffs were evaluated to classify patients as "high risk" for level of care decisions. In the external validation data set consisting of 1,630 patients, the most conservative cutoff (i.e., any predictor present) identified 119 of 119 children with the composite outcome (sensitivity = 100%), but had the lowest specificity (26.3%). The other two decision‐making cutoffs had worse sensitivity (94.1%–96.6%) but improved specificity (67.4%–81.3%). The CHIIDA model lacked the most conservative cutoff and otherwise showed the same or slightly worse performance compared to the other two cutoffs. Conclusions: The KIIDS‐TBI model has high sensitivity and moderate specificity for risk stratifying children with mTBI and intracranial injuries. Use of this CDS tool may help improve the safe, resource‐efficient management of this important patient population. [ABSTRACT FROM AUTHOR] |
|
Copyright of Academic Emergency Medicine is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) |
| قاعدة البيانات: |
Complementary Index |
Full Text Finder