University of Oulu

Vehviläinen, J., Skrifvars, M., Reinikainen, M. et al. External validation of the NeuroImaging Radiological Interpretation System and Helsinki computed tomography score for mortality prediction in patients with traumatic brain injury treated in the intensive care unit: a Finnish intensive care consortium study. Acta Neurochir 164, 2709–2717 (2022).

External validation of the NeuroImaging Radiological Interpretation System and Helsinki computed tomography score for mortality prediction in patients with traumatic brain injury treated in the intensive care unit : a Finnish intensive care consortium study

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Author: Vehviläinen, Juho1; Skrifvars, Markus2; Reinikainen, Matti3;
Organizations: 1Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, P.B. 266, 00029 HUS, Helsinki, Finland
2Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
3Department of Anesthesiology and Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
4Department of Perioperative Services, Intensive Care and Pain Management, Turku University Hospital & University of Turku, Turku, Finland
5Department of Intensive Care and Emergency Medicine Services, Department of Emergency, Anesthesia and Pain Medicine, Tampere University Hospital & University of Tampere, Tampere, Finland
6Research Group of Surgery, Anesthesiology and Intensive Care, Division of Intensive Care, Medical Research Center, Oulu University Hospital & University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
Persistent link:
Language: English
Published: Springer Nature, 2022
Publish Date: 2022-11-18


Background: Admission computed tomography (CT) scoring systems can be used to objectively quantify the severity of traumatic brain injury (TBI) and aid in outcome prediction. We aimed to externally validate the NeuroImaging Radiological Interpretation System (NIRIS) and the Helsinki CT score. In addition, we compared the prognostic performance of the NIRIS and the Helsinki CT score to the Marshall CT classification and to a clinical model.

Methods: We conducted a retrospective multicenter observational study using the Finnish Intensive Care Consortium database. We included adult TBI patients admitted in four university hospital ICUs during 2003–2013. We analyzed the CT scans using the NIRIS and the Helsinki CT score and compared the results to 6-month mortality as the primary outcome. In addition, we created a clinical model (age, Glasgow Coma Scale score, Simplified Acute Physiology Score II, presence of severe comorbidity) and combined clinical and CT models to see the added predictive impact of radiological data to conventional clinical information. We measured model performance using area under curve (AUC), Nagelkerke’s R2 statistics, and the integrated discrimination improvement (IDI).

Results: A total of 3031 patients were included in the analysis. The 6-month mortality was 710 patients (23.4%). Of the CT models, the Helsinki CT displayed best discrimination (AUC 0.73 vs. 0.70 for NIRIS) and explanatory variation (Nagelkerke’s R² 0.20 vs. 0.15). The clinical model displayed an AUC of 0.86 (95% CI 0.84–0.87). All CT models increased the AUC of the clinical model by + 0.01 to 0.87 (95% CI 0.85–0.88) and the IDI by 0.01–0.03.

Conclusion: In patients with TBI treated in the ICU, the Helsinki CT score outperformed the NIRIS for 6-month mortality prediction. In isolation, CT models offered only moderate accuracy for outcome prediction and clinical variables outweighing the CT-based predictors in terms of predictive performance.

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Series: Acta neurochirurgica
ISSN: 0001-6268
ISSN-E: 0942-0940
ISSN-L: 0001-6268
Volume: 164
Issue: 10
Pages: 2709 - 2717
DOI: 10.1007/s00701-022-05353-0
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: Open Access funding provided by University of Helsinki including Helsinki University Central Hospital. Independent funding support has been received from Helsinki University Hospital (State funding, Finland VTR TYH2018227); Finska Läkaresällskapet; Medicinska Understödsföreningen Liv & Hälsa; and Svenska Kulturfonden. The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript. The first and last author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
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