The majority of traumatic brain injuries (TBIs) are categorized as mild, according to a baseline Glasgow Coma Scale (GCS) score of 13–15. 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 externally validate models predicting 3–12-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 Rivermead Post-Concussion Symptoms Questionnaire (RPQ) results available 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 Corticosteroid Randomisation After Significant Head Injury (CRASH) trial for prediction of GOSE <5 discriminated best (C-index 0.78 and 0.79), but were poorly calibrated. The best performing models for PPCS included 2-week symptoms (C-index 0.75 and 0.76). In conclusion, none of the prognostic models for early prediction of GOSE and PPCS has both good calibration and discrimination in persons with mild TBI. In future studies, prognostic models should be tailored to the population with mild TBI, predicting relevant end-points based on readily available predictors.

中文翻译：

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轻度创伤性脑损伤后整体功能结果和脑震荡后症状的预测：欧洲神经创伤协作性创伤性脑损伤有效性研究 (CENTER-TBI) 中预后模型的外部验证

根据基线格拉斯哥昏迷量表 (GCS) 评分为 13-15，大多数创伤性脑损伤 (TBI) 被归类为轻度。用于预测轻度 TBI 后功能结果和持续脑震荡后症状 (PPCS) 的预后模型很少得到外部验证。我们旨在从外部验证预测轻度 TBI 成人 3-12 个月格拉斯哥结局扩展 (GOSE) 或 PPCS 的模型。我们分析了来自外伤性脑损伤协作欧洲神经创伤有效性研究 (CENTER-TBI) 项目的数据，该项目包括 2862 名患有轻度 TBI 的成人，2374 名可获得 6 个月的 GOSE，Rivermead 脑震荡后症状问卷 (RPQ) 结果可用于1605 名参与者。模型性能基于校准（以图形方式并以斜率和截距为特征）和辨别力（C 指数）进行评估。我们验证了五个已发布的 6 个月 GOSE 模型和三个 6 个月 PPCS 评分模型。这些模型对结果使用了不同的临界值，有些模型包括在受伤后 2 周测量的症状。辨别能力差异很大（C 指数在 0.58 和 0.79 之间）。在严重头部损伤后皮质类固醇随机化 (CRASH) 试验中开发的用于预测 GOSE <5 的模型最能区分（C 指数 0.78 和 0.79），但校准不佳。PPCS 的最佳表现模型包括 2 周症状（C 指数 0.75 和 0.76）。总之，用于早期预测 GOSE 和 PPCS 的预后模型都没有在轻度 TBI 患者中具有良好的校准和区分能力。