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Article: Can USMLE and COMLEX-USA Scores Predict At-Risk Emergency Medicine Residents' Performance on In-Training Examinations?

Plewa, Michael C / Ledrick, David J / Jenkins, Kenneth / Orqvist, Aaron / McCrea, Michael

2024 Volume 16, Issue 4, Page(s) e58684

Abstract: Purpose: The United States Medical Licensing Examination (USMLE) and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) scores are standard methods used to determine residency candidates' medical knowledge. The authors were interested in ... ...

Abstract	Purpose: The United States Medical Licensing Examination (USMLE) and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) scores are standard methods used to determine residency candidates' medical knowledge. The authors were interested in using the USMLE and COMLEX part 2 scores in our emergency medicine (EM) residency program to identify at-risk residents who may have difficulty on the in-training exam (ITE) and to determine the cutoff values under which an intern could be given an individualized study plan to ensure medical knowledge competency. Methods: The authors abstracted the USMLE and COMLEX part 2 scores and the American Board of Emergency Medicine (ABEM) ITE scores for a cohort of first-year EM residents graduating years 2010-2022, converting raw scores to percentiles, and compared part 2 and ABEM ITE scores with Pearson's correlation, a Bland-Altman analysis of bias and 95% limits of agreement, and ROC analysis to determine optimal the cut-off values for predicting ABEM ITE < 50 Results: Scores were available for 152 residents, including 93 USMLE and 88 COMLEX exams. The correlations between part 2 scores and ABEM ITE were r = 0.36 (95%CI: 0.17, 0.52; p < 0.001) for USMLE and r = 0.50 (95%CI: 0.33, 0.64; p < 0.001) for COMLEX. Bias and limits of agreement for both part 2 scores were -14 ± 63% for USMLE and 13 ± 50% for COMLEX in predicting the ABEM ITE scores. USMLE < 37 Conclusion: USMLE and COMLEX part 2 scores have a very limited role in identifying those at risk of low ITE performance, suggesting that other factors should be considered to identify interns in need of medical knowledge remediation.
Language	English
Publishing date	2024-04-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.58684
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Article: Rapid transition to home omalizumab treatment for chronic spontaneous urticaria during the COVID-19 pandemic: A patient perspective.

King, Catherine / Cox, Fionnuala / Sloan, Anne / McCrea, Patricia / Edgar, J David / Conlon, Niall

The World Allergy Organization journal

2021 Volume 14, Issue 10, Page(s) 100587

Abstract: Efforts to reduce non-urgent hospital attendances during the COVID-19 pandemic have been the focus of much attention from healthcare professionals worldwide. In Ireland, due to funding constraints omalizumab is only available for hospital-based ... ...

Abstract	Efforts to reduce non-urgent hospital attendances during the COVID-19 pandemic have been the focus of much attention from healthcare professionals worldwide. In Ireland, due to funding constraints omalizumab is only available for hospital-based administration. Fifty-eight patients with chronic spontaneous urticaria and angioedema (CSU) receiving omalizumab in our centre were rapidly transitioned to home self-administration at the start of the pandemic. We conducted an anonymised patient survey after 3 months of home therapy with the aim of characterizing the patient experience throughout this period. 41 patients participated in our questionnaire (71% response rate). 93% of patients favored self-injection of omalizumab from home, with respondents citing cost savings, time savings, improved flexibility, fewer hospital visits, and less risk of exposure to COVID-19 infection as particular benefits. Concerns regarding home administration including injecting incorrectly, forgetting a dose, or having a reaction were reported very infrequently. Eighty-three percent (83%) of patients wished to continue with home therapy long-term. This survey highlights broadly positive experiences for patients rapidly transitioning to home omalizumab administration. This data will be useful to inform healthcare funders in decisions regarding patient-centred care in CSU. Facilitating home omalizumab therapy in suitable CSU patients should be strongly considered in the post-pandemic setting.
Language	English
Publishing date	2021-09-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2581968-9
ISSN	1939-4551
ISSN	1939-4551
DOI	10.1016/j.waojou.2021.100587
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Article ; Online: A Review of Implementation Concepts and Strategies Surrounding Traumatic Brain Injury Clinical Care Guidelines.

Lumba-Brown, Angela / Prager, Eric M / Harmon, Nicole / McCrea, Michael A / Bell, Michael J / Ghajar, Jamshid / Pyne, Scott / Cifu, David X

Journal of neurotrauma

2022 Volume 38, Issue 23, Page(s) 3195–3203

Abstract: Despite considerable efforts to advance the science surrounding traumatic brain injury (TBI), formal efforts supporting the current and future implementation of scientific findings within clinical practice and healthcare policy are limited. While many ... ...

Abstract	Despite considerable efforts to advance the science surrounding traumatic brain injury (TBI), formal efforts supporting the current and future implementation of scientific findings within clinical practice and healthcare policy are limited. While many and varied guidelines inform the clinical management of TBI across the spectrum, clinicians and healthcare systems are not broadly adopting, implementing, and/or adhering to them. As part of the Brain Trauma Blueprint TBI State of the Science, an expert workgroup was assembled to guide this review article, which describes: (1) possible etiologies of inadequate adoption and implementation; (2) enablers to successful implementation strategies; and (3) strategies to mitigate the barriers to adoption and implementation of future research.
MeSH term(s)	Brain Injuries, Traumatic/therapy ; Guideline Adherence ; Humans ; Implementation Science ; Practice Guidelines as Topic
Language	English
Publishing date	2022-01-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	645092-1
ISSN	1557-9042 ; 0897-7151
ISSN (online)	1557-9042
ISSN	0897-7151
DOI	10.1089/neu.2021.0067
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Article: Network analysis and relationship of symptom factors to functional outcomes and quality of life following mild traumatic brain injury: a TRACK-TBI study.

Eagle, Shawn R / Jain, Sonia / Sun, Xiaoying / Preszler, Jonathan / McCrea, Michael A / Giacino, Joseph T / Manley, Geoffrey T / Okonkwo, David O / Nelson, Lindsay D

Frontiers in neurology

2023 Volume 14, Page(s) 1308540

Abstract: Introduction: Mild traumatic brain injury (mTBI) is a heterogenous injury which can be difficult to characterize and manage. Using cross-sectional network analysis (NA) to conceptualize mTBI symptoms offers an innovative solution to identify how mTBI ... ...

Abstract	Introduction: Mild traumatic brain injury (mTBI) is a heterogenous injury which can be difficult to characterize and manage. Using cross-sectional network analysis (NA) to conceptualize mTBI symptoms offers an innovative solution to identify how mTBI symptoms relate to each other. The centrality hypothesis of network theory posits that certain symptoms in a network are more relevant (central) or have above average influence over the rest of the network. However, no studies have used NA to characterize the interrelationships between symptoms in a cohort of patients who presented with mTBI to a U.S. Level 1 trauma center emergency department and how subacute central symptoms relate to long-term outcomes. Methods: Patients with mTBI (Glasgow Coma Scale = 13-15) evaluated across 18 U.S. Level 1 trauma centers from 2013 to 2019 completed the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at 2 weeks (W2) post-injury ( Results: Network structure did not differ across timepoints, indicating no difference in symptoms/factors influence on the overall symptom network across time. The cognitive factor had the highest expected influence at W2 (1.761), M3 (1.245), and M6 (1.349). Fatigue had the highest expected influence at M12 (1.275). The emotional factor was the only other node with expected influence >1 at any timepoint, indicating disproportionate influence of emotional symptoms on overall symptom burden (M3 = 1.011; M6 = 1.076). Discussion: Several symptom factors at 2-weeks post-injury were more strongly associated with incomplete recovery and/or poorer injury-related quality of life at 6 and 12 months post-injury than previously validated demographic and clinical covariates. The network analysis suggests that emotional, cognitive, and fatigue symptoms may be useful treatment targets in this population due to high centrality and activating potential of the overall symptom network.
Language	English
Publishing date	2023-12-12
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2023.1308540
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Article ; Online: Long-term Multidomain Patterns of Change After Traumatic Brain Injury: A TRACK-TBI LONG Study.

Brett, Benjamin L / Temkin, Nancy / Barber, Jason K / Okonkwo, David O / Stein, Murray / Bodien, Yelena G / Corrigan, John / Diaz-Arrastia, Ramon / Giacino, Joseph T / McCrea, Michael A / Manley, Geoffrey T / Nelson, Lindsay D

Neurology

2023 Volume 101, Issue 7, Page(s) e740–e753

Abstract: Background and objectives: Traumatic brain injury (TBI) may be a chronic condition carrying risk of future sequelae; few prospective studies examine long-term postinjury outcomes. We examined the prevalence of functional, cognitive, and psychiatric ... ...

Abstract	Background and objectives: Traumatic brain injury (TBI) may be a chronic condition carrying risk of future sequelae; few prospective studies examine long-term postinjury outcomes. We examined the prevalence of functional, cognitive, and psychiatric change outcomes from 1 to 7 years postinjury. Methods: Transforming Research and Clinical Knowledge in TBI LONG (TRACK-TBI LONG) participants were prospectively enrolled within 24 hours of injury and followed up to 1 year postinjury; a subset participated in long-term follow-up from 2 to 7 years postinjury. Reliable change thresholds for the Brief Test of Adult Cognition by Telephone General Composite (cognition) and Brief Symptom Inventory (BSI)-18 (psychiatric) were derived from orthopedic trauma controls (OTCs). Multiple assessments were completed (postinjury baseline assessment and 2 or 3 visits 2-7 years postinjury) within a sample subset. Change was assessed for functional outcome (Glasgow Outcome Scale-Extended [GOSE]) and self-report/informant report of decline. Prevalence ratios for outcomes classified as stable, improved, and declined were reported individually and collectively. The Fisher exact test and log-binomial regression models examined factors associated with decline and improvement. Results: Of the sample (N = 1,264; mild TBI [mTBI], Glasgow Coma Scale [GCS] 13-15, n = 917; moderate-to-severe TBI [msTBI], GCS 3-12, n = 193; or OTC n = 154), "stable" was the most prevalent outcome. Functional outcome showed the highest rates of decline, regardless of TBI severity (mild = 29%; moderate/severe = 23%). When measures were collectively considered, rates of decline included mTBI (21%), msTBI (26%), and OTC (15%). Age and preinjury employment status were associated with functional decline (per 10 years; relative risk [RR] 1.16, 95% CI 1.07-1.25, Discussion: Function across domains at 1-year postinjury, a common recovery benchmark, undergoes change across the subsequent 6 years. Results support consideration of TBI as a chronic evolving condition and suggest continued monitoring, rehabilitation, and support is required to optimize long-term independence and quality of life.
MeSH term(s)	Adult ; Humans ; Prospective Studies ; Quality of Life/psychology ; Brain Injuries, Traumatic/epidemiology ; Brain Injuries, Traumatic/complications ; Brain Concussion/complications ; Glasgow Coma Scale
Language	English
Publishing date	2023-06-21
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000207501
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Article ; Online: Determining minimally clinically important differences for outcome measures in patients with chronic motor deficits secondary to traumatic brain injury.

McCrea, Michael A / Cramer, Steven C / Okonkwo, David O / Mattke, Soeren / Paadre, Susan / Bates, Damien / Nejadnik, Bijan / Giacino, Joseph T

Expert review of neurotherapeutics

2021 Volume 21, Issue 9, Page(s) 1051–1058

Abstract: Objective: To determine minimally clinically important differences (MCIDs) for Disability Rating Scale (DRS), Fugl-Meyer Upper Extremity Subscale (FM-UE), Fugl-Meyer Lower Extremity Subscale (FM-LE), and Fugl-Meyer Motor Scale (FMMS) in patients with ... ...

Abstract	Objective: To determine minimally clinically important differences (MCIDs) for Disability Rating Scale (DRS), Fugl-Meyer Upper Extremity Subscale (FM-UE), Fugl-Meyer Lower Extremity Subscale (FM-LE), and Fugl-Meyer Motor Scale (FMMS) in patients with chronic motor deficits secondary to traumatic brain injury (TBI). Methods: Retrospective analysis from the 1-year, double-blind, randomized, surgical sham-controlled, Phase 2 STEMTRA trial (NCT02416492), in which patients with chronic motor deficits secondary to TBI (N = 61) underwent intracerebral stereotactic implantation of modified bone marrow-derived mesenchymal stromal (SB623) cells. MCIDs for DRS, FM-UE, FM-LE, and FMMS were triangulated with distribution-based, anchor-based, and Delphi panel estimates. Results: Triangulated MCIDs were: 1) -1.5 points for the Disability Rating Scale; 2) 6.2 points for the Fugl-Meyer Upper Extremity Subscale; 3) 3.2 points for the Fugl-Meyer Lower Extremity Subscale; and 4) 8.4 points for the Fugl-Meyer Motor Scale. Conclusions: For the first time in the setting of patients with chronic motor deficits secondary to TBI, this study reports triangulated MCIDs for: 1) DRS, a measure of global outcome; and 2) Fugl-Meyer Scales, measures of motor impairment. These findings guide the use of DRS and Fugl-Meyer Scales in the assessment of global disability outcome and motor impairment in future TBI clinical trials.
MeSH term(s)	Brain Injuries, Traumatic/complications ; Disability Evaluation ; Humans ; Outcome Assessment, Health Care ; Recovery of Function ; Retrospective Studies ; Stroke ; Stroke Rehabilitation
Language	English
Publishing date	2021-08-26
Publishing country	England
Document type	Clinical Trial, Phase II ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2112534-X
ISSN	1744-8360 ; 1473-7175
ISSN (online)	1744-8360
ISSN	1473-7175
DOI	10.1080/14737175.2021.1968299
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Article ; Online: Profiles of Cognitive Functioning at 6 Months After Traumatic Brain Injury Among Patients in Level I Trauma Centers: A TRACK-TBI Study.

Bryant, Andrew M / Rose, Nathan B / Temkin, Nancy R / Barber, Jason K / Manley, Geoffrey T / McCrea, Michael A / Nelson, Lindsay D / Badjatia, Neeraj / Gopinath, Shankar / Keene, C Dirk / Madden, Christopher / Ngwenya, Laura B / Puccio, Ava / Robertson, Claudia / Schnyer, David / Taylor, Sabrina R / Yue, John K

JAMA network open

2023 Volume 6, Issue 12, Page(s) e2349118

Abstract: Importance: Cognitive dysfunction is common after traumatic brain injury (TBI), with a well-established dose-response relationship between TBI severity and likelihood or magnitude of persistent cognitive impairment. However, patterns of cognitive ... ...

Abstract	Importance: Cognitive dysfunction is common after traumatic brain injury (TBI), with a well-established dose-response relationship between TBI severity and likelihood or magnitude of persistent cognitive impairment. However, patterns of cognitive dysfunction in the long-term (eg, 6-month) recovery period are less well known. Objective: To characterize the prevalence of cognitive dysfunction within and across cognitive domains (processing speed, memory, and executive functioning) 6 months after injury in patients with TBI seen at level I trauma centers. Design, setting, and participants: This prospective longitudinal cohort study used data from Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) and included patients aged 17 years or older presenting at 18 US level I trauma center emergency departments or inpatient units within 24 hours of head injury, control individuals with orthopedic injury recruited from the same centers, and uninjured friend and family controls. Participants were enrolled between March 2, 2014, and July 27, 2018. Data were analyzed from March 5, 2020, through October 3, 2023. Exposures: Traumatic brain injury (Glasgow Coma Scale score of 3-15) or orthopedic injury. Main outcomes and measures: Performance on standard neuropsychological tests, including premorbid cognitive ability (National Institutes of Health Toolbox Picture Vocabulary Test), verbal memory (Rey Auditory Verbal Learning Test), processing speed (Wechsler Adult Intelligence Scale [4th edition] Processing Speed Index), and executive functioning (Trail Making Test). Results: The sample included 1057 persons with TBI (mean [SD] age, 39.3 [16.4] years; 705 [67%] male) and 327 controls without TBI (mean [SD] age, 38.4 [15.1] years; 222 [68%] male). Most persons with TBI demonstrated performance within 1.5 SDs or better of the control group (49.3% [95% CI, 39.5%-59.2%] to 67.5% [95% CI, 63.7%-71.2%] showed no evidence of impairment). Similarly, 64.4% (95% CI, 54.5%-73.4%) to 78.8% (95% CI, 75.4%-81.9%) of participants demonstrated no evidence of cognitive decline (defined as performance within 1.5 SDs of estimated premorbid ability). For individuals with evidence of either cognitive impairment or decline, diverse profiles of impairment across memory, speed, and executive functioning domains were observed (ie, the prevalence was >0 in each of the 7 combinations of impairment across these 3 cognitive domains for most TBI subgroups). Conclusions and relevance: In this cohort study of patients seen at level I trauma centers 6 months after TBI, many patients with TBI demonstrated no cognitive impairment. Impairment was more prevalent in persons with more severe TBI and manifested in variable ways across individuals. The findings may guide future research and treatment recommendations.
MeSH term(s)	United States ; Adult ; Humans ; Male ; Female ; Cohort Studies ; Longitudinal Studies ; Prospective Studies ; Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/epidemiology ; Cognition ; Inpatients
Language	English
Publishing date	2023-12-01
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.49118
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Article ; Online: Functional Recovery, Symptoms, and Quality of Life 1 to 5 Years After Traumatic Brain Injury.

Nelson, Lindsay D / Temkin, Nancy R / Barber, Jason / Brett, Benjamin L / Okonkwo, David O / McCrea, Michael A / Giacino, Joseph T / Bodien, Yelena G / Robertson, Claudia / Corrigan, John D / Diaz-Arrastia, Ramon / Markowitz, Amy J / Manley, Geoffrey T

JAMA network open

2023 Volume 6, Issue 3, Page(s) e233660

Abstract: Importance: Many level I trauma center patients experience clinical sequelae at 1 year following traumatic brain injury (TBI). Longer-term outcome data are needed to develop better monitoring and rehabilitation services.: Objective: To examine ... ...

Abstract	Importance: Many level I trauma center patients experience clinical sequelae at 1 year following traumatic brain injury (TBI). Longer-term outcome data are needed to develop better monitoring and rehabilitation services. Objective: To examine functional recovery, TBI-related symptoms, and quality of life from 1 to 5 years postinjury. Design, setting, and participants: This cohort study enrolled trauma patients across 18 US level I trauma centers between 2014 and 2018. Eligible participants were enrolled within 24 hours of injury and followed up to 5 years postinjury. Data were analyzed January 2023. Exposures: Mild TBI (mTBI), moderate-severe TBI (msTBI), or orthopedic traumatic controls (OTC). Main outcomes and measures: Functional independence (Glasgow Outcome Scale-Extended [GOSE] score 5 or higher), complete functional recovery (GOSE score, 8), better (ie, lower) TBI-related symptom burden (Rivermead Post Concussion Symptoms Questionnaire score of 15 or lower), and better (ie, higher) health-related quality of life (Quality of Life After Brain Injury Scale-Overall Scale score 52 or higher); mortality was analyzed as a secondary outcome. Results: A total 1196 patients were included in analysis (mean [SD] age, 40.8 [16.9] years; 781 [65%] male; 158 [13%] Black, 965 [81%] White). mTBI and OTC groups demonstrated stable, high rates of functional independence (98% to 100% across time). While odds of independence were lower among msTBI survivors, the majority were independent at 1 year (72%), and this proportion increased over time (80% at 5 years; group × year, P = .005; independence per year: odds ratio [OR] for msTBI, 1.28; 95% CI, 1.03-1.58; OR for mTBI, 0.81; 95% CI, 0.64-1.03). For other outcomes, group differences at 1 year remained stable over time (group × year, P ≥ .44). Odds of complete functional recovery remained lower for persons with mTBI vs OTC (OR, 0.39; 95% CI, 0.28-0.56) and lower for msTBI vs mTBI (OR, 0.34; 95% CI, 0.24-0.48). Odds of better TBI-related symptom burden and quality of life were similar for both TBI subgroups and lower than OTCs. Mortality between 1 and 5 years was higher for msTBI (5.5%) than mTBI (1.5%) and OTC (0.7%; P = .02). Conclusions and relevance: In this cohort study, patients with previous msTBI displayed increased independence over 5 years; msTBI was also associated with increased mortality. These findings, in combination with the persistently elevated rates of unfavorable outcomes in mTBI vs controls imply that more monitoring and rehabilitation are needed for TBI.
MeSH term(s)	Humans ; Male ; Adult ; Female ; Cohort Studies ; Quality of Life ; Brain Injuries, Traumatic/epidemiology ; Brain Injuries ; Brain Concussion/epidemiology
Language	English
Publishing date	2023-03-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.3660
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Article ; Online: Performance of the IMPACT and CRASH prognostic models for traumatic brain injury in a contemporary multicenter cohort: a TRACK-TBI study.

Yue, John K / Lee, Young M / Sun, Xiaoying / van Essen, Thomas A / Elguindy, Mahmoud M / Belton, Patrick J / Pisică, Dana / Mikolic, Ana / Deng, Hansen / Kanter, John H / McCrea, Michael A / Bodien, Yelena G / Satris, Gabriela G / Wong, Justin C / Ambati, Vardhaan S / Grandhi, Ramesh / Puccio, Ava M / Mukherjee, Pratik / Valadka, Alex B /

Tarapore, Phiroz E / Huang, Michael C / DiGiorgio, Anthony M / Markowitz, Amy J / Yuh, Esther L / Okonkwo, David O / Steyerberg, Ewout W / Lingsma, Hester F / Menon, David K / Maas, Andrew I R / Jain, Sonia / Manley, Geoffrey T

Journal of neurosurgery

2024 , Page(s) 1–13

Abstract: Objective: The International Mission on Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) and Corticosteroid Randomization After Significant Head Injury (CRASH) prognostic models for mortality and outcome after traumatic brain ...

Abstract	Objective: The International Mission on Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) and Corticosteroid Randomization After Significant Head Injury (CRASH) prognostic models for mortality and outcome after traumatic brain injury (TBI) were developed using data from 1984 to 2004. This study examined IMPACT and CRASH model performances in a contemporary cohort of US patients. Methods: The prospective 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study (enrollment years 2014-2018) enrolled subjects aged ≥ 17 years who presented to level I trauma centers and received head CT within 24 hours of TBI. Data were extracted from the subjects who met the model criteria (for IMPACT, Glasgow Coma Scale [GCS] score 3-12 with 6-month Glasgow Outcome Scale-Extended [GOSE] data [n = 441]; for CRASH, GCS score 3-14 with 2-week mortality data and 6-month GOSE data [n = 831]). Analyses were conducted in the overall cohort and stratified on the basis of TBI severity (severe/moderate/mild TBI defined as GCS score 3-8/9-12/13-14), age (17-64 years or ≥ 65 years), and the 5 top enrolling sites. Unfavorable outcome was defined as GOSE score 1-4. Original IMPACT and CRASH model coefficients were applied, and model performances were assessed by calibration (intercept [< 0 indicated overprediction; > 0 indicated underprediction] and slope) and discrimination (c-statistic). Results: Overall, the IMPACT models overpredicted mortality (intercept -0.79 [95% CI -1.05 to -0.53], slope 1.37 [1.05-1.69]) and acceptably predicted unfavorable outcome (intercept 0.07 [-0.14 to 0.29], slope 1.19 [0.96-1.42]), with good discrimination (c-statistics 0.84 and 0.83, respectively). The CRASH models overpredicted mortality (intercept -1.06 [-1.36 to -0.75], slope 0.96 [0.79-1.14]) and unfavorable outcome (intercept -0.60 [-0.78 to -0.41], slope 1.20 [1.03-1.37]), with good discrimination (c-statistics 0.92 and 0.88, respectively). IMPACT overpredicted mortality and acceptably predicted unfavorable outcome in the severe and moderate TBI subgroups, with good discrimination (c-statistic ≥ 0.81). CRASH overpredicted mortality in the severe and moderate TBI subgroups and acceptably predicted mortality in the mild TBI subgroup, with good discrimination (c-statistic ≥ 0.86); unfavorable outcome was overpredicted in the severe and mild TBI subgroups with adequate discrimination (c-statistic ≥ 0.78), whereas calibration was nonlinear in the moderate TBI subgroup. In subjects ≥ 65 years of age, the models performed variably (IMPACT-mortality, intercept 0.28, slope 0.68, and c-statistic 0.68; CRASH-unfavorable outcome, intercept -0.97, slope 1.32, and c-statistic 0.88; nonlinear calibration for IMPACT-unfavorable outcome and CRASH-mortality). Model performance differences were observed across the top enrolling sites for mortality and unfavorable outcome. Conclusions: The IMPACT and CRASH models adequately discriminated mortality and unfavorable outcome. Observed overestimations of mortality and unfavorable outcome underscore the need to update prognostic models to incorporate contemporary changes in TBI management and case-mix. Investigations to elucidate the relationships between increased survival, outcome, treatment intensity, and site-specific practices will be relevant to improve models in specific TBI subpopulations (e.g., older adults), which may benefit from the inclusion of blood-based biomarkers, neuroimaging features, and treatment data.
Language	English
Publishing date	2024-03-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	3089-2
ISSN	1933-0693 ; 0022-3085
ISSN (online)	1933-0693
ISSN	0022-3085
DOI	10.3171/2023.11.JNS231425
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Article ; Online: Introducing the Sport Concussion Assessment Tool 6 (SCAT6).

Echemendia, Ruben J / Brett, Benjamin L / Broglio, Steven / Davis, Gavin A / Giza, Christopher C / Guskiewicz, Kevin M / Harmon, Kimberly G / Herring, Stanley / Howell, David R / Master, Christina L / Valovich McLeod, Tamara C / McCrea, Michael / Naidu, Dhiren / Patricios, Jon / Putukian, Margot / Walton, Samuel R / Schneider, Kathryn J / Burma, Joel S / Bruce, Jared M

British journal of sports medicine

2023 Volume 57, Issue 11, Page(s) 619–621

Language	English
Publishing date	2023-06-14
Publishing country	England
Document type	Editorial
ZDB-ID	600592-5
ISSN	1473-0480 ; 0306-3674
ISSN (online)	1473-0480
ISSN	0306-3674
DOI	10.1136/bjsports-2023-106849
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