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Predicting outcomes after trauma to the brain

UMMS researchers help develop novel tool to predict survival after penetrating brain injury

By Sarah Willey and Bryan Goodchild

UMass Medical School Communications

October 26, 2016

A new tool developed by researchers at UMass Medical School, the R Adams Cowley Shock Trauma Center at the University of Maryland and Yale School of Medicine may help predict a person’s chance of survival after a gunshot wound or other penetrating brain injury.

A study examining the tool was published in the October online issue of Neurology, the journal of the American Academy of Neurology.

“Gunshot wounds are the number one cause of penetrating traumatic brain injuries,” said lead author Susanne Muehlschlegel, MD, MPH, associate professor of neurology. “Much of our knowledge about surviving such injuries comes from the battlefield, not from shootings among civilians. The first thing family members want to know when a loved one has a brain injury is whether they will survive. Being better able to determine the average person’s chance of survival could help doctors and families make important decisions about medical treatments.”

Dr. Muehlschlegel worked with Timothy A. Emhoff, MD, clinical associate professor of surgery and chief of trauma surgery & surgical critical care, and Didem Ayturk, MS, biostatistician in the Center for Outcomes Research at UMMS, and Kevin Sheth, MD, senior author, and associate professor of neurology & neurosurgery at Yale School of Medicine, to analyze 10 years of data from two level-one trauma centers: UMass Memorial Medical Center and the R Adams Cowley Shock Trauma Center in Baltimore. After examining the medical records of 413 penetrating brain injury cases, most of which were gunshot wounds, researchers looked to see which factors were associated with surviving the injury, both in the hospital and six months later.

Using the new tool they developed, the SPIN-Score (Surviving Penetrating Injury to the Brain), two factors were by far the strongest predictors of survival: how well a person’s pupils responded to light and how well the person could move in response to stimuli, such as obeying commands or withdrawing from pain, which is called the motor Glasgow Coma Scale. The researchers found several other predictors of survival but say the first two were so strong that the rest improved the accuracy of their prediction only slightly.

“Overall, the SPIN-Score correctly predicted whether people would survive with an excellent accuracy of 96 percent, which is very high,” Muehlschlegel said.

The survival rate overall was 42 percent; no participants died in the six months after leaving the hospital. Women had a 76 percent higher chance of survival, but exactly why is unclear. There was an 80 percent increased risk of dying if a gunshot wound was self-inflicted.

The SPIN-Score for those in the study ranged from 4 to 52, with higher scores indicating a greater chance of survival. For this group, 98 percent of those with scores of 35 and higher survived while only 3 percent with a score of 20 or less survived. There were no patients in this cohort with a SPIN-Score of 16 or less who survived.

Muehlschlegel and Sheth agree more research is needed to validate the SPIN-Score, so for now, it remains a preliminary prediction tool.

“Developing this tool is an important step toward improving overall outcomes,” added Muehlschlegel.