IMPACT: International Mission for Prognosis and Analysis of Clinical Trials in TBI.
Traumatic Brain Injury (TBI) may afflict us all, but young adult males are particularly at risk.
IMPACT is an international multidisciplinary effort to advance clinical research programmes in search of better treatment.
Nearly 10 years of work has resulted in the development of a prognostic calculator for establishing prognosis in individual patients, proposals for standardization of data collection in TBI studies (common data elements) and recommendations for improving the design and analysis of TBI studies.
It is hoped that these recommendations will substantially increase possibilities for proving efficacy of new treatments.
We greatly welcome any feedback you may have.
Based on extensive prognostic analysis the IMPACT investigators have developed prognostic models for predicting 6 month outcome in adult patients with moderate to severe head injury (Glasgow Coma Scale <=12) on admission.
By entering the characteristics into the calculator, the models will provide an estimate of the expected outcome at 6 months.
We present three models of increasing complexity (Core, Core + CT, Core + CT + Lab).
These models were developed and validated in collaboration with the CRASH trial collaborators on large numbers of individual patient data (the IMPACT database).
The models discriminate well, and are particularly suited for purposes of classification and characterization of large cohorts of patients.
Extreme caution is required when applying the estimated prognosis to individual patients.
Predicting outcome after traumatic brain injury: Development and international validation of prognostic scores based on admission characteristics.
Steyerberg EW, Mushkudiani N, Perel P, Butcher I, Lu J, McHugh GS, Murray GD, Marmarou A, Roberts I, Habbema JD, Maas AI.
PLoS Med. 2008 August; 5(8): e165.
Grant support was provided by NIH NS 42691.
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The sequential prediction models may be used as an aid to estimate 6 month outcome in patients with severe or moderate traumatic brain injury (TBI).
However, the prediction rule can only complement, never replace, clinical judgment and can therefore be used only as a decision-support system.
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