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Evaluation Of Computed Tomography Scoring Systems In The Prediction Of Short-term Mortality In Traumatic Brain Injury Patients From A Low- To Middle-income Country Pmc
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- Datasets are split into two categories, continuous and noncontinuous datasets.
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- While studies such as TUSZ included the total seizure duration, most datasets did not.
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- All patients were treated according to the local protocols based on existing international guidelines and recommendations at that time (24).
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- Integration into well-established TBI outcome prediction schemes such as IMPACT (9) and Corticosteroid Randomization After Significant Head injury (10) will require further study.
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Most modern TBI biomarker studies have investigated the individual prediction abilities of different molecules. The studies show that single biomarkers tend to have low specificities when sensitivity is set above 90%. Therefore, individual blood-based biomarkers may not be applicable for clinical practice as stand-alone tools (19, 28, 31), which is expected due to the complexity of TBI. Combining several biomarkers or combining biomarkers with clinical characteristics have been suggested to improve diagnostic and predictive abilities (31, 32). Thus, biomarkers may provide additional value in outcome prediction of TBI when used in combination with predictive neuroimaging scores. However, studies on blood-based biomarkers complementing head imaging scores are scarce.
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52 In our study, the effect of this bias is minimal, as we were only interested in how many of the studies use the data rather than the results themselves. Based on Table 8, the number of seizure events is largely affected by the total size of the dataset (Total recorded segments x recordings length per segment).
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However, we do not consider this a major limitation, since EEG signals are the main focus and the scalp datasets normally follow the international 10–20 system or the Nomenclature 10–10 system. The CHB‐MIT Scalp EEG dataset consists of long‐term and short‐term continuous data in segments depending on the patients. However, the dataset has a 10 seconds gap between the continuous segments due to the limitations of the recording device and some longer gaps in certain patients. TUSZ contains multiple pruned short‐term continuous segments from multiple sessions across all patients. Pruning refers to cases where segments that are of interest from the same recording section are cut and joined together. The Neurovista ictal dataset, made available via Epilepsyecosystem.org, does not fall into any category, since it only consists of multiple recordings of seizure events for patients.
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IMPACT data were added in regression by the insert model, which forces the entry of all variables. In addition, the scores were added in a second block to evaluate its increment in the standard model. To systematize and stratify TBI patients based on CT imaging characteristics, several classification systems have been proposed; the most popular used in practice are Marshall CT classification and Rotterdam and Helsinki CT scores. The lower limits of detection, the lower limits of quantification, and the calibration ranges for the blood-based biomarkers are shown in Supplementary Table 1. One patient had an S100B level below the lower limit of detection range, and therefore, the concentration of 1 pg/ml was applied, permitting statistical analysis.
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Artifacts such as muscle or eye movement were removed from the continuous recording by visual inspection to form the final dataset from the University of Bonn. 24 In addition to removing artifacts, the EEG segments chosen in the final dataset had to satisfy the criterion of at least weak stationarity. 24
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The current results suggest that outcome prediction ability of the HCTS could be significantly enhanced with rapid point-of-care measurement of plasma levels of IL-10 and Aβ40. This may allow the identification of initially neurologically stable patients who, however, are developing severe secondary brain injury that significantly impairs their recovery. To better illuminate the predictive power of biomarkers in patients with CT-positive findings, we also investigated their abilities in distinguishing between patients with complete and incomplete recovery. The best-performing biomarkers were the same as in discrimination of patients with favorable and unfavorable outcomes, but the predictive performance of the HCTS was low. The HCTS was designed to predict functional outcome according to the GOS (13).
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The discretely higher Rotterdam CT AUC value was not statistically significant when compared to the Helsinki CT, and p values for the comparison are presented in Supplementary Table S1. Receiver operating characteristic curves for prediction of (A) 14-day mortality and (B) in-hospital mortality. Lastly, like the other temporal properties, the sampling frequency also varies across the datasets. The remaining datasets have constant sampling frequency within the dataset, with the highest sampling frequency of 512 Hz in Siena Scalp EEG and the lowest in the University of Bonn at 173.6 Hz. Sampling frequency of the datasets can also be found in Table 8.
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