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Gold standard prognostic models for long-term outcome in patients with severe traumatic brain injury (TBI) use admission characteristics and are considered useful in some areas but not for clinical practice. In this study, we aimed to build prognostic models for 6-month Glasgow Outcome Score (GOS) in patients with severe TBI, combining baseline characteristics with physiological, treatment, and injury severity data collected during the first 24 h after injury. We used a training dataset of 472 TBI subjects and several data mining algorithms to predict the long-term neurological outcome. Performance of these algorithms was assessed in an independent (test) sample of 158 subjects. The least absolute shrinkage and selection operator (LASSO) led to the highest prediction accuracy (area under the receiving operating characteristic curve = 0.86) in the test set. The most important post-baseline predictor of GOS was the best motor Glasgow Coma Scale (GCS) recorded in the first day post-injury. The LASSO model containing the best motor GCS and baseline variables as predictors outperformed a model with baseline data only. TBI patient physiology of the first day-post-injury did not have a major contribution to patient prognosis six months after injury. In conclusion, 6-month GOS in patients with TBI can be predicted with good accuracy by the end of the first day post-injury, using hospital admission data and information on the best motor GCS achieved during those first 24 h post-injury. Passed the first day after injury, important physiological predictors could emerge from landmark analyses, leading to prediction models of higher accuracy than the one proposed in the current research. [ABSTRACT FROM AUTHOR]

Cerebral dysfunction caused by traumatic brain injury may adversely affect cerebral hemodynamics and oxygenation leading to worse outcomes if oxygen capacity is decreased due to anemia. In a randomized clinical trial of 200 patients comparing transfusion thresholds <7 g/dl versus 10 g/dl, where transfusion of leukoreduced packed red blood cells was used to maintain the assigned hemoglobin threshold, no long-term neurological difference was detected. The current study examines secondary outcome measures of intracranial pressure (ICP), cerebral perfusion pressure (CPP), and brain tissue oxygenation (PbtO2) in patients enrolled in this randomized clinical trial. We observed a lower hazard for death (hazard ratio [HR]=0.12, 95% confidence interval [CI]=0.02-0.99) during the first 3 days post-injury, and a higher hazard for death after three days (HR=2.55, 95% CI=1.00-6.53) in the 10 g/dl threshold group as compared to the 7 g/dL threshold group. No significant differences were observed for ICP and CPP but MAP was slightly lower in the 7 g/dL group, although the decreased MAP did not result in increased hypotension. Overall brain tissue hypoxia events were not significantly different in the two transfusion threshold groups. When the PbtO2 catheter was placed in normal brain, however, tissue hypoxia occurred in 25% of patients in the 7 g/dL threshold group, compared to 10.2% of patients in the 10 g/dL threshold group ( p=0.04). Although we observed a few differences in hemodynamic outcomes between the transfusion threshold groups, none were of major clinical significance and did not affect long-term neurological outcome and mortality. [ABSTRACT FROM AUTHOR]