Long-term survival after traumatic brain injury part I

External validity of prognostic models

Jordan C. Brooks, Robert M. Shavelle, David J. Strauss, Flora Hammond, Cynthia L. Harrison-Felix

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives To develop prognostic models for long-term survival in adults with traumatic brain injury (TBI) and to assess their external validity in 2 independent populations. Design Survival analysis. Setting Post-discharge from rehabilitation units and long-term follow-up at regional centers. Participants Two cohorts of long-term survivors of TBI (N=12,481): the Traumatic Brain Injury Model Systems (TBIMS) cohort comprised 7365 persons who were admitted to a TBIMS facility and were assessed at ≥1 years postinjury, and the California Department of Developmental Services (CDDS) cohort comprised 5116 persons who sustained a TBI and received long-term services from the CDDS. Interventions Not applicable. Main Outcome Measures Survival/mortality. Results Older age, male sex, and severity of disability in walking and feeding were significant predictors of increased long-term mortality rates (all P<.05, both databases). The CDDS model predicted 623 deaths for persons in the TBIMS cohort, with an observed-to-expected ratio of.94 (95% confidence interval [CI], 0.87-1.02). The TBIMS model predicted a total of 525 deaths for persons in the CDDS cohort, with an observed-to-expected ratio of 1.08 (95% CI, 0.99-1.17). Regression calibration statistics were satisfactory, and both models ranked survival times well from shortest to longest (TBIMS: C index,.78; 95% CI,.76-.80; CDDS: C index,.80; 95% CI,.78-.82). Conclusions Long-term survival prognosis in TBI is related to age, sex, and severity of disability. When compared on the basis of these factors, the survival estimates derived from the TBIMS and CDDS cohorts are found to be similar. The close agreement between model predictions and actual mortality rates confirm the external validity of the prognostic models presented herein.

Original languageEnglish
Pages (from-to)994-999
Number of pages6
JournalArchives of Physical Medicine and Rehabilitation
Volume96
Issue number6
DOIs
StatePublished - Jun 1 2015

Fingerprint

Survival
Confidence Intervals
Mortality
Traumatic Brain Injury
Survival Analysis
Calibration
Walking
Survivors
Rehabilitation
Outcome Assessment (Health Care)
Databases
Population

Keywords

  • Brain injuries
  • Mortality
  • Prognosis
  • Rehabilitation
  • Survival
  • Validation studies

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Medicine(all)

Cite this

Long-term survival after traumatic brain injury part I : External validity of prognostic models. / Brooks, Jordan C.; Shavelle, Robert M.; Strauss, David J.; Hammond, Flora; Harrison-Felix, Cynthia L.

In: Archives of Physical Medicine and Rehabilitation, Vol. 96, No. 6, 01.06.2015, p. 994-999.

Research output: Contribution to journalArticle

Brooks, Jordan C. ; Shavelle, Robert M. ; Strauss, David J. ; Hammond, Flora ; Harrison-Felix, Cynthia L. / Long-term survival after traumatic brain injury part I : External validity of prognostic models. In: Archives of Physical Medicine and Rehabilitation. 2015 ; Vol. 96, No. 6. pp. 994-999.
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abstract = "Objectives To develop prognostic models for long-term survival in adults with traumatic brain injury (TBI) and to assess their external validity in 2 independent populations. Design Survival analysis. Setting Post-discharge from rehabilitation units and long-term follow-up at regional centers. Participants Two cohorts of long-term survivors of TBI (N=12,481): the Traumatic Brain Injury Model Systems (TBIMS) cohort comprised 7365 persons who were admitted to a TBIMS facility and were assessed at ≥1 years postinjury, and the California Department of Developmental Services (CDDS) cohort comprised 5116 persons who sustained a TBI and received long-term services from the CDDS. Interventions Not applicable. Main Outcome Measures Survival/mortality. Results Older age, male sex, and severity of disability in walking and feeding were significant predictors of increased long-term mortality rates (all P<.05, both databases). The CDDS model predicted 623 deaths for persons in the TBIMS cohort, with an observed-to-expected ratio of.94 (95{\%} confidence interval [CI], 0.87-1.02). The TBIMS model predicted a total of 525 deaths for persons in the CDDS cohort, with an observed-to-expected ratio of 1.08 (95{\%} CI, 0.99-1.17). Regression calibration statistics were satisfactory, and both models ranked survival times well from shortest to longest (TBIMS: C index,.78; 95{\%} CI,.76-.80; CDDS: C index,.80; 95{\%} CI,.78-.82). Conclusions Long-term survival prognosis in TBI is related to age, sex, and severity of disability. When compared on the basis of these factors, the survival estimates derived from the TBIMS and CDDS cohorts are found to be similar. The close agreement between model predictions and actual mortality rates confirm the external validity of the prognostic models presented herein.",
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T2 - External validity of prognostic models

AU - Brooks, Jordan C.

AU - Shavelle, Robert M.

AU - Strauss, David J.

AU - Hammond, Flora

AU - Harrison-Felix, Cynthia L.

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N2 - Objectives To develop prognostic models for long-term survival in adults with traumatic brain injury (TBI) and to assess their external validity in 2 independent populations. Design Survival analysis. Setting Post-discharge from rehabilitation units and long-term follow-up at regional centers. Participants Two cohorts of long-term survivors of TBI (N=12,481): the Traumatic Brain Injury Model Systems (TBIMS) cohort comprised 7365 persons who were admitted to a TBIMS facility and were assessed at ≥1 years postinjury, and the California Department of Developmental Services (CDDS) cohort comprised 5116 persons who sustained a TBI and received long-term services from the CDDS. Interventions Not applicable. Main Outcome Measures Survival/mortality. Results Older age, male sex, and severity of disability in walking and feeding were significant predictors of increased long-term mortality rates (all P<.05, both databases). The CDDS model predicted 623 deaths for persons in the TBIMS cohort, with an observed-to-expected ratio of.94 (95% confidence interval [CI], 0.87-1.02). The TBIMS model predicted a total of 525 deaths for persons in the CDDS cohort, with an observed-to-expected ratio of 1.08 (95% CI, 0.99-1.17). Regression calibration statistics were satisfactory, and both models ranked survival times well from shortest to longest (TBIMS: C index,.78; 95% CI,.76-.80; CDDS: C index,.80; 95% CI,.78-.82). Conclusions Long-term survival prognosis in TBI is related to age, sex, and severity of disability. When compared on the basis of these factors, the survival estimates derived from the TBIMS and CDDS cohorts are found to be similar. The close agreement between model predictions and actual mortality rates confirm the external validity of the prognostic models presented herein.

AB - Objectives To develop prognostic models for long-term survival in adults with traumatic brain injury (TBI) and to assess their external validity in 2 independent populations. Design Survival analysis. Setting Post-discharge from rehabilitation units and long-term follow-up at regional centers. Participants Two cohorts of long-term survivors of TBI (N=12,481): the Traumatic Brain Injury Model Systems (TBIMS) cohort comprised 7365 persons who were admitted to a TBIMS facility and were assessed at ≥1 years postinjury, and the California Department of Developmental Services (CDDS) cohort comprised 5116 persons who sustained a TBI and received long-term services from the CDDS. Interventions Not applicable. Main Outcome Measures Survival/mortality. Results Older age, male sex, and severity of disability in walking and feeding were significant predictors of increased long-term mortality rates (all P<.05, both databases). The CDDS model predicted 623 deaths for persons in the TBIMS cohort, with an observed-to-expected ratio of.94 (95% confidence interval [CI], 0.87-1.02). The TBIMS model predicted a total of 525 deaths for persons in the CDDS cohort, with an observed-to-expected ratio of 1.08 (95% CI, 0.99-1.17). Regression calibration statistics were satisfactory, and both models ranked survival times well from shortest to longest (TBIMS: C index,.78; 95% CI,.76-.80; CDDS: C index,.80; 95% CI,.78-.82). Conclusions Long-term survival prognosis in TBI is related to age, sex, and severity of disability. When compared on the basis of these factors, the survival estimates derived from the TBIMS and CDDS cohorts are found to be similar. The close agreement between model predictions and actual mortality rates confirm the external validity of the prognostic models presented herein.

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KW - Validation studies

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