Acute Crit Care.  2022 Aug;37(3):429-437. 10.4266/acc.2021.01795.

Development and internal validation of a nomogram for predicting outcomes in children with traumatic subdural hematoma

• Kaewborisutsakul A
• Tunthanathip T

• KMID: 2535307
• DOI: http://doi.org/10.4266/acc.2021.01795

Abstract

Background
A subdural hematoma (SDH) following a traumatic brain injury (TBI) in children can lead to unexpected death or disability. The nomogram is a clinical prediction tool used by physicians to provide prognosis advice to parents for making decisions regarding treatment. In the present study, a nomogram for predicting outcomes was developed and validated. In addition, the predictors associated with outcomes in children with traumatic SDH were determined.
Methods
In this retrospective study, 103 children with SDH after TBI were evaluated. According to the King’s Outcome Scale for Childhood Head Injury classification, the functional outcomes were assessed at hospital discharge and categorized into favorable and unfavorable. The predictors associated with the unfavorable outcomes were analyzed using binary logistic regression. Subsequently, a two-dimensional nomogram was developed for presentation of the predictive model.
Results
The predictive model with the lowest level of Akaike information criterion consisted of hypotension (odds ratio [OR], 9.4; 95% confidence interval [CI], 2.0–42.9), Glasgow coma scale scores of 3–8 (OR, 8.2; 95% CI, 1.7–38.9), fixed pupil in one eye (OR, 4.8; 95% CI, 2.6–8.8), and fixed pupils in both eyes (OR, 3.5; 95% CI, 1.6–7.1). A midline shift ≥5 mm (OR, 1.1; 95% CI, 0.62–10.73) and co-existing intraventricular hemorrhage (OR, 6.5; 95% CI, 0.003–26.1) were also included.
Conclusions
SDH in pediatric TBI can lead to mortality and disability. The predictability level of the nomogram in the present study was excellent, and external validation should be conducted to confirm the performance of the clinical prediction tool.

Keyword

nomogram; pediatric traumatic brain injury; prognosis; subdural hematoma

Figure

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  Figure 1. Forest plot of the adjusted odds ratio (OR) of predictors. CI: confidence interval; GCS: Glasgow coma scale; IVH: intraventricular hemorrhage.

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  Figure 2. Calibration plot of the predictive model. Dxy: somers' dxy rank correlation; C (ROC): concordance statistic (area under the receiver operating characteristic curve).

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  Figure 3. Nomogram predicting unfavorable outcomes in children with traumatic subdural hematoma. GCS: Glasgow coma scale; IVH: intraventricular hemorrhage; MLS: midline shift.

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