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Systematic Review of Multivariable Prognostic Models for Mild Traumatic Brain Injury

Silverberg, Noah D., Gardner, Andrew J., Brubacher, Jeffrey R., Panenka, William J., Li, Jun Jian, Iverson, Grant L.·2015·Journal of Neurotrauma

DOI 10.1089/neu.2014.3600

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Abstract

Prognostic models can guide clinical management and increase statistical power in clinical trials. The availability and adequacy of prognostic models for mild traumatic brain injury (MTBI) is uncertain. The present study aimed to (1) identify and evaluate multivariable prognostic models for MTBI, and (2) determine which pre-, peri-, and early post-injury variables have independent prognostic value in the context of multivariable models. An electronic search of MEDLINE, PsycINFO, PubMed, EMBASE, and CINAHL databases for English-language MTBI cohort studies from 1970–2013 was supplemented by Web of Science citation and hand searching. This search strategy identified 7789 articles after removing duplicates. Of 182 full-text articles reviewed, 26 met eligibility criteria including (1) prospective inception cohort design, (2) prognostic information collected within 1 month post-injury, and (3) 2+variables combined to predict clinical outcome (e.g., post-concussion syndrome) at least 1 month later. Independent reviewers extracted sample characteristics, study design features, clinical outcome variables, predictor selection methods, and prognostic model discrimination, calibration, and cross-validation. These data elements were synthesized qualitatively. The present review found no multivariable prognostic model that adequately predicts individual patient outcomes from MTBI. Suboptimal methodology limits their reproducibility and clinical usefulness. The most robust prognostic factors in the context of multivariable models were pre-injury mental health and early post-injury neuropsychological functioning. Women and adults with early post-injury anxiety also have worse prognoses. Relative to these factors, the severity of MTBI had little long-term prognostic value. Future prognostic studies should consider a broad range of biopsychosocial predictors in large inception cohorts.

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Lingsma H., , Yue J.K., , Mass A., , Steyerberg E.W., , Manley G.T., , Cooper S.R., , Dams-O'Connor K., , Gordon W.A., , Menon D.K., , Mukherjee P., , Okonkwo D.O., , Puccio A.M., , Schnyer D.M., , Valadka A.B., , Vassar M.J., , and Yuh E.L. (2014). Outcome prediction after mild and complicated mild traumatic brain injury: external validation of existing models and identification of new predictors using the TRACK-TBI pilot study. J. Neurotrauma Epub ahead of print.

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Silverberg, N. D., Iaccarino, M. A., Panenka, W. J., Iverson, G. L., McCulloch, K. L., Dams-O’Connor, K., Reed, N., McCrea, M., Cogan, A. M., Park Graf, M. J., et al. (2020) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2019.10.179 · Cited by 366
“The more symptoms a patient has soon after mTBI, the more symptoms they tend to have weeks and months later(81,83-85) In adults, preinjury mental health problems and postinjury psychological distress (symptoms of depression and anxiety) are robust predictors of prolonged recovery.(76,81,83,85,87)”
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Authors: Silverberg, N. D., Gardner, A. J., Brubacher, J. R., Panenka, W. J., Li, J. J., & Iverson, G. L.
Affiliations: University of British Columbia (CA)
University of Newcastle Australia (AU)
Simon Fraser University (CA)
Harvard University (US)
Corresponding author: Silverberg, Noah D.
ORCID: Silverberg, Noah D.
Gardner, Andrew J.
Brubacher, Jeffrey R.
Panenka, William J.
Iverson, Grant L.
Venue: Journal of Neurotrauma
Publisher: SAGE Publications
Published: 2015-04
Volume: 32
Issue: 8
Pages: 517-526
ISSN: 0897-7151 (ISSN-L)
1557-9042
DOI: 10.1089/neu.2014.3600
OpenAlex: W1974797523
Cited by: 393
References: 70
Citations by year: 2026: 11 · 2025: 32 · 2024: 38 · 2023: 33 · 2022: 41 · 2021: 44 · 2020: 33 · 2019: 37 · 2018: 73 · 2017: 29 · 2016: 12 · 2015: 10
FWCI: 2.27
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Journal of Neurotrauma (publishedVersion)
PubMed (publishedVersion)
NOVA (University of Newcastle Australia) (submittedVersion)
Topics: Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
Health Sciences › Medicine › Clinical Neurology › Long-Term Effects of COVID-19
Keywords: mild traumatic brain injury, concussion, prognostic model, post-concussion syndrome, prognostic factors, neuropsychological performance, injury severity, discrimination and calibration
MeSH terms: Brain Injuries, Humans, Models, Neurological, Prognosis

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Systematic Review of Multivariable Prognostic Models for Mild Traumatic Brain Injury

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