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IMPACT Score for Traumatic Brain Injury

Validation of the Prognostic Tool in a Spanish Cohort

Egea-Guerrero, Juan José MD, PhD; Rodríguez-Rodríguez, Ana PhD; Gordillo-Escobar, Elena MD; Fernández-Delgado, Esperanza MD; Martínez-Roldán, Ángela MD; Roldán-Reina, Álvaro MD; Durán-Martínez, Pilar MD; de Vega-Ríos, Enrique MD; Freire-Aragón, María Dolores MD; Vilches-Arenas, Ángel MD, PhD; Murillo-Cabezas, Francisco MD, PhD; Quintana-Díaz, Manuel MD, PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP; Brenner, Lisa PhD, ABPP; Malec, James PhD, ABPP

The Journal of Head Trauma Rehabilitation: January/February 2018 - Volume 33 - Issue 1 - p 46–52
doi: 10.1097/HTR.0000000000000292
Original Articles

Background: The aim of this work was to validate the IMPACT (International Mission for Prognosis and Analysis of Clinical Trials in TBI) model in a Spanish cohort of patients with moderate-severe TBI (traumatic brain injury).

Setting: Two level I neurotrauma centers.

Participants: Patients admitted to these hospitals between 2011 and 2014 with a diagnosis of TBI and a Glasgow Coma Scale score of 12 or less.

Design: Prospective observational study.

Main Measures: We collected prospectively the clinical variables included in the IMPACT models. Outcome evaluation was prospectively done at 6-month follow-up according to the Glasgow Outcome Scale.

Results: A total of 290 patients were included in the study. Forty-seven patients (16.2%) died within 6 months post-TBI, and 74 patients (25.5%) had an unfavorable outcome. The Hosmer-Lemeshow test revealed that there was no difference between observed and predicted outcomes; hence, the 3 models displayed adequate calibration for predicting 6-month mortality or unfavorable outcome. The receiver operating characteristic curve indicated that the 3 models (Core, Extended, and Lab) could accurately discriminate between favorable and unfavorable outcomes, as well as between survival and mortality (P < .001).

Conclusion: The IMPACT model validates prediction of 6-month outcomes in a Spanish population of moderate-severe TBI. IMPACT Lab model is the one that presents a higher discriminative capacity. These results encourage the implementation of the IMPACT model as a prognostic tool in the management of patients with TBI.

NeuroCritical Care Unit (Drs Egea-Guerrero, Gordillo-Escobar, Fernández-Delgado, Martínez-Roldán, Roldán-Reina, Durán-Martínez, Freire-Aragón, and Murillo-Cabezas) and Emergency Department (Dr Rodríguez-Rodríguez), Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville, Seville, Spain; Internal Medicine, La Princesa University Hospital, Madrid, Spain (Dr de Vega-Ríos); Department of Preventive Medicine and Public Health, Virgen Macarena University Hospital, University of Seville, Seville, Spain (Dr Vilches-Arenas); and Emergency Department, University Hospital La Paz, Madrid, Spain (Dr Quintana-Díaz).

Corresponding Author: Ana Rodríguez-Rodríguez, PhD, Emergency Department, Virgen del Rocio University Hospital, IBIS/CSIC/University of Seville, Avda Manuel Siurot s/n, 41013 Seville, Spain (;

The invaluable help of residents and nurses from the NeuroCritical Care Unit is gratefully appreciated.

The authors declare no conflicts of interest.

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