External Validation of CRASH Prognostic Model in an Urban Tertiary Care Public University Hospital

Abstract

Introduction

Trauma represents 9% of global mortality, where traumatic brain injuries are the leading cause in low-middle income countries, most commonly due to road traffic injuries. The multicenter randomized controlled trial CRASH (corticosteroid randomization after significant head injury) published a prediction model to estimate prognosis in traumatic brain injury patients. This prediction model was derived based on data from high-, low-, and middle-income countries. The external validity of this prediction model was not assessed in low and middle-income countries. To fill this gap, we aim to external validate the CRASH prediction model in traumatic brain injury (TBI) patients in India, a lower-middle-income country.

Methods

We conducted a prospective observational study at the General Surgery department of an urban tertiary care hospital in India. We collected data on the 14-d mortality and 6-mo unfavorable outcomes in patients with TBI. Calibration and discrimination of the CRASH models (basic and computed tomography [CT] model) comparing the observed and predicted outcomes using logistic regression, and area under the curve was analyzed to validate the model.

Results

In this study, 417 patients with the median age of 40 y and age range of 18-95 y were evaluated. There was no significant difference between the calibration of the models in prediction of a 14-d mortality (basic P = 0.082, CT P = 0.067) and 6-mo unfavorable outcome (basic P = 0.688, CT P = 0.204). The area under the receiver operating characteristic curve in basic and CT models in prediction of 14-d mortality were 0.885 and 0.885 respectively. In addition, the area under the receiver operating characteristic curve in basic and CT models in prediction of 6-mo unfavorable outcome were 0.901 and 0.896, respectively.

Conclusions

The results of this study showed that the CRASH basic and CT model both accurately predict 14 d mortality and 6 mo unfavorable outcomes of TBI patients in an urban tertiary care public university hospital in India.