Diagnosis of in-hospital mortality using admission CT perfusion in severe traumatic brain injury patients (ACT-TBI study)
Notice bibliographique
Résumé
BACKGROUND: Severe traumatic brain injury (TBI) stands as the leading cause of post-injury hospitalization, disability, and mortality globally. Imaging serves as a cornerstone in the assessment of patients with severe TBI and CT Perfusion (CTP) has emerged as an early prognostic tool. Our study aims to validate CTP features of non-survivable brain injury, upon hospital admission to characterize in-hospital mortality, through a well-powered prospective cohort study. METHODS: In a prospective cohort study, adult patients with severe TBI were recruited to undergo whole head CTP at the time of their first imaging. Interpretation of the CTP images were conducted by two independent neuroradiologists (JS and ME), blinded to clinical results and each other's assessment. Non-survivable brain injury was defined as a matched decrease of cerebral blood flow (CBF) and cerebral blood volume (CBV) in the brainstem. The results of CTP were not disclosed to the clinical team providing patient care, and the patients received standard institutional management. The primary outcome was a binary outcome of in-hospital mortality. The primary validity analysis involved calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for features of non-survivable brain injury on admission CTP compared to in-hospital mortality, along with 95% confidence intervals. RESULTS: Out of the 201 patients initially enrolled in the study, 195 patients (mean age 42.9 years; Male- 160, 82%) were included in the final analysis. Among the participants, a total of 55 patients (28.2%) died during their hospital stay. The odds ratio (OR) was highest for the presence of intracranial hemorrhage (ICH) (OR-20.25; 95% CI- 7.08-71.80, p < 0.001) and gun shot wound (GSW) (OR-22.67; 95% CI- 3.66-257.5, p = 0.003), which were independently associated with in-hospital mortality. With every decade of age, there was 1.77 times of (95% CI- 1.37-2.36, p < 0.001) higher odds of in-hospital mortality. Of the 55 patients with in-hospital mortality, 17 (31%) met the criteria of non-survival brain injury on the CTP at the time of hospital admission. Both CTP and CT-angiogram (CTA)A had 100% specificity and PPV. The highest sensitivity of 33% and NPV of 80% was seen with non-survivable criteria of CTP. As a result, this variable exhibited the highest accuracy of 82% with an area under the curve (AUC) of 0.67. The inter-rater reliability for CTP ranged from poor (kappa = 0.07) to fair (kappa = 0.44), indicating variability in agreement between raters. In contrast, the inter-rater reliability for CTA scales ranged from fair (kappa = 0.39) to substantial (kappa = 0.79), suggesting more consistent agreement among raters. CTP was found to be safe as no patients experience any complications associated with CTP. CONCLUSION: CTP features of non-survivable brain injury showed very high specificity and positive predictive value for diagnosing in-hospital mortality in patients with severe TBI.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».