Development and Validation of a Nomogram for Predicting the Mortality after Penetrating Traumatic Brain Injury

Abstract

<strong>Objective:</strong> To determine the factors associated with mortality in penetrating brain injury (PTBI) and proposed the nomogram predicting the risk of death.<br /> <strong>Methods:</strong> A retrospective cohort study was conducted on all patients who had sustained PTBI between 2009 and 2018. Collected data included clinical characteristics, neuroimaging findings, treatment, and outcomes. Prognostic factors analysis was conducted using a forest plot. Therefore, the nomogram was developed and validated. For the propose of evaluation, the nomogram's sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), Receiver Operating Characteristic (ROC) curve and the area under the receiver operating characteristic (AUC) were determined for validating the optimal cut-off point of the total scores. <br /> <strong>Results:</strong> During the study period, 62 individuals enrolled. In the univariate analysis, factors associated with the morality were normal pupils' reactivity to light (OR 0.04, <em>p</em> < 0.001), hypotension (OR 9.91, <em>p</em><0.001), hypoxia (OR 10.2, <em>p</em>=0.04), bihemispheric injuries (OR 19.0, <em>p</em>=0.001), multilobar injuries (OR 21.5, p< 0.001), subarachnoid hemorrhage (OR 6.9, <em>p</em>= 0.02), intraventricular hemorrhage (OR 26.6, <em>p</em>= 0.006), basal cistern effacement (OR 28.8, , <em>p</em><0.001), midline shift <span style="text-decoration: underline;">></span>5 mm (OR 0.19, <em>p</em><0.001) were significantly associated with death. In multivariable analysis, hypotension (OR 8.82, <em>p</em>=0.03), normal pupils' reactivity to light (OR 0.07, <em>p</em> =0.01), midline shift >5 mm (OR 18.23, <em>p</em><0.007) were significantly associated with death. The nomogram's sensitivity, specificity, PPV, NPV, and AUC for predicting mortality (total score ≥ 100) were 80%, 92.6%, 72.7%, 95.0%, and, 0.86 respectively. <br /> <strong>Conclusions: </strong>PTBI is the fatal injury depend on both clinical and neuroimaging parameters. The nomogram is the alternative method providing prognostic parameters toward implication for clinical decision making.