Open AccessPrognostic Research in Traumatic Brain Injury: Markers, Modeling, and Methodological Principles
Author(s) -
Isabel R.A. Retel Helmrich,
Hester F. Lingsma,
Alexis F. Turgeon,
JoséMiguel Yamal,
Ewout W. Steyerberg
Publication year - 2021
Publication title -
journal of neurotrauma
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.653
H-Index - 149
eISSN - 1557-9042
pISSN - 0897-7151
DOI - 10.1089/neu.2019.6708
Subject(s) - generalizability theory , traumatic brain injury , medicine , outcome (game theory) , prognostic model , disease , intensive care medicine , clinical study design , research design , psychology , clinical trial , oncology , overall survival , psychiatry , developmental psychology , social science , mathematics , mathematical economics , sociology
Prognostic assessment in traumatic brain injury (TBI) is embedded deeply in clinical care. Considering the limitations of current prognostic indicators, there is increasing interest in understanding the role of new biomarkers, and in finding other prognostic indicators of long-term outcomes following TBI. New prognostic indicators may result in the development of more accurate prediction models that could be useful for both risk stratification and clinical decision making. We aimed to review methodological issues and provide tentative guidelines for prognostic research in TBI. Prognostic factor research focuses on the role of a specific patient or disease-related characteristic in relation to outcome. Typically, univariable relations of the prognostic factor are studied, followed by analyses adjusting for other variables related to the outcome. Following existing guidelines, we emphasize the importance of transparent reporting of patient and specimen characteristics, study design, clinical end-points, and statistical analysis. Prognostic model research considers combinations of predictors, with challenges for model specification, estimation, evaluation, validation, and presentation. We highlight modern approaches and opportunities related to missing values, exploration of non-linear effects, and assessing between-study heterogeneity. Prognostic research in TBI can be improved if key methodological principles are adhered to and when research is performed in collaboration among multiple centers to ensure generalizability.