Work

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

Year: 2025

Type: article

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.

Source: Journal of Surgical Research

DOI: 10.1016/j.jss.2025.03.040

Authors: Asif Mulla, Devi Bavishi, Monty Khajanchi, Martin Gerdin Wärnberg

Institutions: King Edward Memorial Hospital and Seth G.S. Medical College, The University of Texas Health Science Center at Houston, Karolinska University Hospital, Karolinska Institutet

Language: English

Topic: Traumatic Brain Injury and Neurovascular Disturbances

Subfield: Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,590