Traumatic brain injury (TBI) is a complex injury that has a multi-faceted recovery process. The current “gold standard” for classifying severity of TBI symptoms is the Glasgow Outcome Scale (GOSE), a crude measure of overall dysfunction after TBI. Exploratory factor analysis performed on TRACK-TBI Pilot (N = 297) identified candidate multi-variate outcome measures of neuropsychological impairment and cognitive speed and flexibility at 6 months post-TBI that were confirmed in data from the COBRIT study (N = 645) using confirmatory factor analysis. These new outcome measures were used as the dependent variables in an ordinal logistic regression model, using common data elements (CDE) collected in the emergency department as independent variables, including basic demographics, socioeconomic status, medical history, and measures of blood alcohol and blood pressure. We directly compared these prediction models with the GOSE as the 6-month outcome variable and found that in both the TRACK-TBI pilot and COBRIT studies, both neuropsychiatric complications (approx. 36.0% and 22.3% variance explained) and cognitive speed and flexibility (approx. 33.9% and 24.5% variance explained) were better explained by the prediction model, compared with GOSE (approx. 19.9% and 14.4% variance explained), respectively. While differences in overall distributions of impairment between TRACK-TBI pilot and COBRIT exist and should be explored further for applications of these prediction models, we think these multi-variate end-points more accurately characterize patients' functioning at six-months post-TBI. A multi-variate assessment of end-points seems especially important for characterizing TBI outcomes in cases where gross impairment, such as those measured by the GOSE, may be less evident.

中文翻译：

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外伤性脑损伤终点临床预测指标的多模式评估

创伤性脑损伤 (TBI) 是一种复杂的损伤，具有多方面的恢复过程。目前对 TBI 症状严重程度进行分类的“金标准”是格拉斯哥预后量表 (GOSE)，这是 TBI 后整体功能障碍的粗略衡量标准。对 TRACK-TBI Pilot (N = 297) 进行的探索性因素分析确定了 TBI 后 6 个月神经心理障碍、认知速度和灵活性的候选多变量结果指标，这些指标在 COBRIT 研究 (N = 645) 的数据中得到证实，使用验证性因素分析。这些新的结果测量被用作有序逻辑回归模型中的因变量，使用在急诊科收集的通用数据元素 (CDE) 作为自变量，包括基本人口统计学、社会经济地位、病史、以及血液酒精和血压的测量。我们直接将这些预测模型与 GOSE 作为 6 个月的结果变量进行比较，发现在 TRACK-TBI 试验和 COBRIT 研究中，神经精神并发症（解释了大约 36.0% 和 22.3% 的方差）以及认知速度和灵活性（与 GOSE 相比（解释了约 19.9% 和 14.4% 的方差），预测模型更好地解释了约 33.9% 和 24.5% 的方差解释）。虽然 TRACK-TBI 试验和 COBRIT 之间的总体损伤分布存在差异，应进一步探索这些预测模型的应用，但我们认为这些多变量终点更准确地表征了 TBI 后 6 个月患者的功能。