Conor Gillespie
University of Liverpool School of Medicine, UK
The Walton Centre, UK
Posters & Accepted Abstracts: J Neurol Neurophysiol
Introduction: Both CRASH and IMPACT models have been developed in recent years to prognosticate traumatic brain injury (TBI).
However, there is no clear evidence as to how acceptance for neurosurgical intervention to tertiary centres affects outcome compared to
other centres. There is also predictive uncertainty with regards to if acceptance affects the ability of CRASH and IMPACT to prognosticate
TBI.
Methods: Patients referred to a tertiary neuroscience centre from December 2014-January 2016 with a suspected TBI were retrospectively
examined. For each model, the predicted survival and overall outcome were compared to the actual outcome on admission and at six months
post injury, stratified by patient age and acceptance for neurosurgical intervention.
Results: The results indicated that 161 patients met the initial criteria; mean age 65 years (SD=21). Both CRASH and IMPACT correctly
predicted six-month mortality rates and functional outcomes in most patients (range 61.7-82.4%), with better predictive performance for
patients not accepted to the centre (range 84-98%). There was also no significant difference in the initial survival of elderly patients if
accepted (78% [95% CI 50.6-104] vs. 81% [95% CI 67.8-94.8] but were lower for those not accepted (24% [95% CI 4.2-43.7] vs. 76%
[95% CI 63.5-88.5], p=0.027).
Discussion: The lesser ability of CRASH and IMPACT models to predict outcomes when accepted suggests that acceptance to specialist
centres may be able to improve outcome. Patients >65 years also had good survival rates on admission and at six months if accepted. This
suggests more optimistic treatment and acceptance of appropriate patients should be considered.
