ABSTRACT

Aim

To develop and validate a prediction model for disability among young patients with acquired brain injury (ABI) after the acute phase.

Methods

Within a nationwide cohort of 446 15–30-year-old ABI-patients, we predicted disability in terms of Glasgow Outcome Scale – Extended (GOS-E) <7 12 months after baseline assessment in outpatient neurorehabilitation clinics. We studied 22 potential predictors covering demographic and medical factors, clinical tests, and self-reported fatigue and alcohol/drug consumption. The model was developed using multivariable logistic regression analysis and validated by 5-fold cross-validation and geographical validation. The model’s performance was assessed by receiver operating characteristic curves and calibration plots.

Results

Baseline assessment took place a median of 12 months post-ABI. Low GOS-E (range 1–8 (best)) and Functional Independence Measure (range 18–126 (best)) along with high mental fatigue (range 4–20 (worst)) predicted disability. The model showed high validity and performance with an area under the curve of 0.82 (95% confidence interval (CI) 0.77, 0.87) in the cross-validation and 0.81 (95% CI 0.73, 0.88) in the geographical validation.

Conclusion

We developed and validated a parsimonious model which effectively predicted disability. The model may be useful to guide decision-making in outpatient neurorehabilitation clinics treating young patients with ABI.

中文翻译：

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急性期后获得性脑损伤的青少年和年轻人残疾的预测因素

摘要

目的

开发和验证急性期后获得性脑损伤 (ABI) 年轻患者残疾的预测模型。

方法

在 446 名 15-30 岁 ABI 患者的全国队列中，我们在门诊神经康复诊所基线评估后 12 个月根据格拉斯哥结局量表扩展 (GOS-E) <7 预测残疾。我们研究了 22 个潜在的预测因素，包括人口统计学和医学因素、临床测试以及自我报告的疲劳和酒精/药物消耗。该模型是使用多变量逻辑回归分析开发的，并通过 5 折交叉验证和地理验证进行验证。该模型的性能是通过接收器操作特征曲线和校准图来评估的。

结果

基线评估发生在 ABI 后的中位数 12 个月。低 GOS-E（范围 1-8（最佳））和功能独立性测量（范围 18-126（最佳））以及高度精神疲劳（范围 4-20（最差））预测残疾。该模型显示出较高的有效性和性能，交叉验证的曲线下面积为 0.82（95% 置信区间 (CI) 0.77, 0.87），地理验证的曲线下面积为 0.81（95% CI 0.73, 0.88）。

结论

我们开发并验证了一个有效预测残疾的简约模型。该模型可能有助于指导门诊神经康复诊所治疗年轻 ABI 患者的决策。