Nomogram prediction model for neurological deterioration in elderly patients with moderate traumatic brain injury
SUN Pengxia
XIAO Yang
Abstract：Objective To explore the risk factors for early neurological deterioration(END)during hospitalization in elderly patients with moderate traumatic brain injury(TBI)and to construct a nomogram prediction model.Methods The clinical data of 219 elderly patients with moderate TBI were analyzed retrospectively,and the occurrence of END during hospitalization was recorded.Multivariate logistic regression analysis was applied to identify the factors associated with END in elderly patients with moderate TBI during hospitalization.A nomogram prediction model was then established,and its discriminative ability,calibration performance,and clinical utility were evaluated.Results END occurred in 67 elderly patients with moderate TBI during hospitalization.The END group had lower Glasgow Coma Scale(GCS)scores upon admission(P<0.05)and greater hemorrhage volumes(P<0.05)compared to the non-END group.The proportions of patients with Marshall CT gradeⅢ,sluggish pupillary response,seizures,vasospasm,and cerebral edema were higher in the END group(all P<0.05).Additionally,levels of prothrombin time(PT),D-dimer,and neuronspecific enolase(NSE)were higher in the END group(all P<0.05).Multivariate logistic regression analysis revealed that Marshall CT gradeⅢ,vasospasm,cerebral edema,and elevated D-dimer levels were risk factors for END in elderly patients with moderate TBI(all P<0.05).Based on these risk factors,a nomogram prediction model was constructed.Validation showed that the model had high calibration accuracy,with a mean absolute error of 0.002,a C-index of 0.897,and a Hosmer-Lemeshow P-value of 0.73.The area under the curve(AUC)for predicting END during hospitalization was 0.896(95%CI:0.848-0.933),with a sensitivity of 91.04%and a specificity of 86.84%,indicating excellent predictive performance.Conclusions The nomogram prediction model,based on Marshall CT grade,vasospasm,cerebral edema,and elevated D-dimer levels,can visually and accurately predict the risk of END in elderly patients with moderate TBI.
Keywords：brain injuriestraumaticearly neurological deteriorationvasospasmcerebral edemanomogramprediction model
Publication Date：2025-10-20
Online Publishing Date：2025-12-01(First online date of this platform, not the publication date of the document)
Pages：7( 598-604 )