External validation of prognostic models predicting outcome after chronic subdural hematoma
Acta Neurochirurgica, vol. 164, pp. 2719–2730
Abstract
BACKGROUND: Several prognostic models for outcomes after chronic subdural hematoma (CSDH) treatment have been published in recent years. However, these models are not sufficiently validated for use in daily clinical practice. We aimed to assess the performance of existing prediction models for outcomes in patients diagnosed with CSDH. METHODS: We systematically searched relevant literature databases up to February 2021 to identify prognostic models for outcome prediction in patients diagnosed with CSDH. For the external validation of prognostic models, we used a retrospective database, containing data of 2384 patients from three Dutch regions. Prognostic models were included if they predicted either mortality, hematoma recurrence, functional outcome, or quality of life. Models were excluded when predictors were absent in our database or available for < 150 patients in our database. We assessed calibration, and discrimination (quantified by the concordance index C) of the included prognostic models in our retrospective database. RESULTS: We identified 1680 original publications of which 1656 were excluded based on title or abstract, mostly because they did not concern CSDH or did not define a prognostic model. Out of 18 identified models, three could be externally validated in our retrospective database: a model for 30-day mortality in 1656 patients, a model for 2 months, and another for 3-month hematoma recurrence both in 1733 patients. The models overestimated the proportion of patients with these outcomes by 11% (15% predicted vs. 4% observed), 1% (10% vs. 9%), and 2% (11% vs. 9%), respectively. Their discriminative ability was poor to modest (C of 0.70 [0.63-0.77]; 0.46 [0.35-0.56]; 0.59 [0.51-0.66], respectively). CONCLUSIONS: None of the examined models showed good predictive performance for outcomes after CSDH treatment in our dataset. This study confirms the difficulty in predicting outcomes after CSDH and emphasizes the heterogeneity of CSDH patients. The importance of developing high-quality models by using unified predictors and relevant outcome measures and appropriate modeling strategies is warranted.
Authors 16
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Dana C. Holl corresponding
Erasmus MC · Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Department of Neurology, Haaglanden Medical Centre, Hague, The Netherlands. d.holl@erasmusmc.nl
Department of Neurosurgery, Erasmus Medical Centre, Erasmus MC Stroke Centre, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. d.holl@erasmusmc.nl
Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands. d.holl@erasmusmc.nl
Department of Neurosurgery, Erasmus Medical Centre, Erasmus MC Stroke Centre, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Affiliation as printed
Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Amsterdam University Medical Centers
Affiliation as printed
Department of Neurosurgery, Amsterdam Medical Centre, Amsterdam, The Netherlands
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Amsterdam University Medical Centers
Affiliation as printed
Department of Neurosurgery, Amsterdam Medical Centre, Amsterdam, The Netherlands
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Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Department of Neurology, Haaglanden Medical Centre, Hague, The Netherlands
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Leiden University · Leiden University Medical Center · Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
University Neurosurgical Centre Holland (UNCH), Leiden University Medical Centre, Haaglanden Medical Centre, Haga Teaching Hospital, Leiden, The Netherlands
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Affiliation as printed
Department of Neurology, Isala Hospital Zwolle, Zwolle, The Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Amsterdam University Medical Centers
Affiliation as printed
Department of Neurosurgery, Amsterdam Medical Centre, Amsterdam, The Netherlands
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Medisch Spectrum Twente · University of Twente
Affiliation as printed
Clinical Neurophysiology Group, University of Twente, Enschede, The Netherlands
Department of Neurosurgery, NeurocenterMedisch Spectrum Twente, Enschede, The Netherlands
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Affiliation as printed
Department of Neurosurgery, Erasmus Medical Centre, Erasmus MC Stroke Centre, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Affiliation as printed
Department of Neurosurgery, Erasmus Medical Centre, Erasmus MC Stroke Centre, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Affiliation as printed
Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
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Affiliation as printed
Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
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