{"title":"A nomogram for the prediction of traumatic intracranial abnormalities in the elderly: Development and validation.","authors":"Apisorn Jongjit, Thara Tunthanathip","doi":"10.1016/j.cjtee.2025.03.003","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Traumatic brain injury is a major public health issue and a leading cause of death and disability among the elderly. As a result, traumatic intracerebral abnormalities (tICA) are now frequently diagnosed using cranial computed tomography (cCT), which has led to an overuse of this investigation. The present study aimed to develop and validate the nomogram for predicting tICA in the elderly.</p><p><strong>Methods: </strong>This was a retrospective cohort study. The study population consisted of patients who met the following inclusion criteria: (1) aged ≥60 years, as defined by the World Health Organization; (2) admitted to a tertiary referral hospital between January 2015 and December 2022; and (3) underwent cCT scanning upon admission. Patients were excluded if (1) patients' images were unavailable or (2) patients died in the emergency department before hospitalization. The total data was divided into the development cohort (2015-2019, n=2052) to develop the nomogram and the validation cohort (2020-2022, n=310) to test the predictability as temporal validation. Binary logistic regression was used in the construction of the nomogram.</p><p><strong>Results: </strong>There were 2362 patients in the entire cohort. Positive CT scan rates among the elderly amount to 21.3%. Multivariable analysis identified the following factors significantly associated with traumatic intracranial hematoma in the elderly: use of aspirin (odds ratio (OR)=4.49, 95% confidence interval (CI) 3.08-6.54), warfarin usage (OR=6.88, 95% CI 2.99-15.8), traffic accidents (OR=1.98, 95% CI 1.46-2.68), Glasgow coma scale 9-12 (OR=3.24, 95% CI 1.66-6.35), amnesia (OR=1.65, 95% CI 1.17-2.33), nausea or vomiting (OR=12.5, 95% CI 5.56-28.07), seizure (OR=11.42, 95% CI 3.33-39.22), motor weakness (OR=65.45, 95% CI 18.68-229.29), and bleeding per nose or ear (OR=24.81, 95% CI 10.57-14.58). The predictability of the nomogram demonstrated sensitivity, specificity, and an area under the receiver operating characteristic curve of 0.833, 0.788, and 0.889, respectively.</p><p><strong>Conclusion: </strong>According to the temporal validation, the nomogram had an outstanding performance for tICA prediction in the elderly. In the future, the prediction tool will assist clinicians in making judgments and balancing the rate of cCT in clinical practice.</p>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chinese Journal of Traumatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cjtee.2025.03.003","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Traumatic brain injury is a major public health issue and a leading cause of death and disability among the elderly. As a result, traumatic intracerebral abnormalities (tICA) are now frequently diagnosed using cranial computed tomography (cCT), which has led to an overuse of this investigation. The present study aimed to develop and validate the nomogram for predicting tICA in the elderly.
Methods: This was a retrospective cohort study. The study population consisted of patients who met the following inclusion criteria: (1) aged ≥60 years, as defined by the World Health Organization; (2) admitted to a tertiary referral hospital between January 2015 and December 2022; and (3) underwent cCT scanning upon admission. Patients were excluded if (1) patients' images were unavailable or (2) patients died in the emergency department before hospitalization. The total data was divided into the development cohort (2015-2019, n=2052) to develop the nomogram and the validation cohort (2020-2022, n=310) to test the predictability as temporal validation. Binary logistic regression was used in the construction of the nomogram.
Results: There were 2362 patients in the entire cohort. Positive CT scan rates among the elderly amount to 21.3%. Multivariable analysis identified the following factors significantly associated with traumatic intracranial hematoma in the elderly: use of aspirin (odds ratio (OR)=4.49, 95% confidence interval (CI) 3.08-6.54), warfarin usage (OR=6.88, 95% CI 2.99-15.8), traffic accidents (OR=1.98, 95% CI 1.46-2.68), Glasgow coma scale 9-12 (OR=3.24, 95% CI 1.66-6.35), amnesia (OR=1.65, 95% CI 1.17-2.33), nausea or vomiting (OR=12.5, 95% CI 5.56-28.07), seizure (OR=11.42, 95% CI 3.33-39.22), motor weakness (OR=65.45, 95% CI 18.68-229.29), and bleeding per nose or ear (OR=24.81, 95% CI 10.57-14.58). The predictability of the nomogram demonstrated sensitivity, specificity, and an area under the receiver operating characteristic curve of 0.833, 0.788, and 0.889, respectively.
Conclusion: According to the temporal validation, the nomogram had an outstanding performance for tICA prediction in the elderly. In the future, the prediction tool will assist clinicians in making judgments and balancing the rate of cCT in clinical practice.
预测老年人外伤性颅内异常的nomogram: Development and validation。
目的：创伤性脑损伤是一个重大的公共卫生问题，也是老年人死亡和残疾的主要原因。因此，创伤性脑内异常（tICA）现在经常使用颅计算机断层扫描（cCT）进行诊断，这导致了这种调查的过度使用。本研究旨在开发和验证预测老年人tICA的nomogram。方法：回顾性队列研究。研究人群包括符合以下纳入标准的患者：(1)年龄≥60岁，按照世界卫生组织的定义；(2) 2015年1月至2022年12月在三级转诊医院住院；(3)入院时行ct扫描。如果(1)无法获得患者的图像或(2)患者在住院前在急诊科死亡，则排除患者。将总数据分为发展队列（2015-2019年，n=2052）和验证队列（2020-2022年，n=310），以测试可预测性作为时间验证。二值逻辑回归被用于构造模态图。结果：整个队列共有2362例患者。老年人CT扫描阳性率为21.3%。多变量分析发现以下因素与老年人外伤性颅内血肿显著相关：阿司匹林的使用(优势比（OR)=4.49, 95%可信区间（CI） 3.08-6.54），华法林的使用（OR=6.88, 95% CI 2.99-15.8），交通事故（OR=1.98, 95% CI 1.46-2.68），格拉斯哥昏迷量表9-12 (OR=3.24, 95% CI 1.66-6.35)，失忆（OR=1.65, 95% CI 1.17-2.33），恶心或呕吐（OR=12.5, 95% CI 5.56-28.07），癫痫发作（OR=11.42, 95% CI 3.33-39.22），运动无力（OR=65.45, 95% CI 18.68-229.29），鼻部或耳部出血（OR=24.81, 95% CI 10.57-14.58）。nomogram的灵敏度、特异度和受试者工作特征曲线下的面积分别为0.833、0.788和0.889。结论：经时间验证，nomogram对老年人tICA有较好的预测效果。未来，该预测工具将辅助临床医生在临床实践中对cCT率进行判断和平衡。
期刊介绍：
Chinese Journal of Traumatology (CJT, ISSN 1008-1275) was launched in 1998 and is a peer-reviewed English journal authorized by Chinese Association of Trauma, Chinese Medical Association. It is multidisciplinary and designed to provide the most current and relevant information for both the clinical and basic research in the field of traumatic medicine. CJT primarily publishes expert forums, original papers, case reports and so on. Topics cover trauma system and management, surgical procedures, acute care, rehabilitation, post-traumatic complications, translational medicine, traffic medicine and other related areas. The journal especially emphasizes clinical application, technique, surgical video, guideline, recommendations for more effective surgical approaches.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
