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Validation of CRASH Model in Prediction of 14-day Mortality and 6-month Unfavorable Outcome of Head Trauma Patients

Behrooz Hashemi, Mahnaz Amanat, Alireza Baratloo, Mohammad Mehdi Forouzanfar, Farhad Rahmati, Maryam Motamedi, Saeed Safari



Introduction: To date, many prognostic models have been proposed to predict the outcome of patients with
traumatic brain injuries. External validation of these models in different populations is of great importance
for their generalization. The present study was designed, aiming to determine the value of CRASH prognostic
model in prediction of 14-day mortality (14-DM) and 6-month unfavorable outcome (6-MUO) of patients with
traumatic brain injury. Methods: In the present prospective diagnostic test study, calibration and discrimination
of CRASH model were evaluated in head trauma patients referred to the emergency department. Variables
required for calculating CRASH expected risks (ER), and observed 14-DM and 6-MUO were gathered. Then ER
of 14-DM and 6-MUO were calculated. The patients were followed for 6 months and their 14-DM and 6-MUO
were recorded. Finally, the correlation of CRASH ER and the observed outcome of the patients was evaluated.
The data were analyzed using STATA version 11.0. Results: In this study, 323 patients with the mean age of 34.0
´s 19.4 years were evaluated (87.3% male). Calibration of the basic and CT models in prediction of 14-day and
6-month outcome were in the desirable range (P Ç 0.05). Area under the curve in the basic model for prediction
of 14-DM and 6-MUO were 0.92 (95% CI: 0.89–0.96) and 0.92 (95% CI: 0.90–0.95), respectively. In addition,
area under the curve in the CT model for prediction of 14-DM and 6-MUO were 0.93 (95% CI: 0.91–0.97) and
0.93 (95% CI: 0.91–0.96), respectively. There was no significant difference between the discriminations of the
two models in prediction of 14-DM (p Æ 0.11) and 6-MUO (p Æ 0.1). Conclusion: The results of the present
study showed that CRASH prediction model has proper discrimination and calibration in predicting 14-DMand
6-MUO of head trauma patients. Since there was no difference between the values of the basic and CT models,
using the basic model is recommended to simplify the risk calculations.


Prognosis; head injuries, closed; multiple trauma; patient outcome assessment; decision support techniques


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DOI: https://doi.org/10.22037/emergency.v4i4.10751


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