• John A Staples, Jin Wang, Brianna Mills, Nancy Temkin, Mark C Zaros, Gregory J Jurkovich, and Frederick P Rivara.
• Department of Medicine (Drs Staples and Zaros), School of Public Health (Dr Mills), Department of Neurological Surgery (Dr Temkin), and Department of Pediatrics (Dr Rivara), University of Washington, Seattle; Harborview Injury Prevention & Research Center, Seattle, Washington (Drs Staples, Wang, and Rivara and Ms Mills); and Department of Surgery, University of Colorado, Denver (Dr Jurkovich).
• J Head Trauma Rehabil. 2016 Sep 1; 31 (5): E8-E14.

ObjectiveTo examine the performance of the Corticosteroid Randomization After Significant Head injury (CRASH) trial prognostic model in older patients with traumatic brain injury.SettingThe National Study on Costs and Outcomes of Trauma cohort, established at 69 hospitals in the United States in 2001 and 2002.ParticipantsAdults with traumatic brain injury and an initial Glasgow Coma Scale score of 14 or less.DesignThe CRASH-CT model predicting death within 14 days was deployed in all patients. Model performance in older patients (aged 65-84 years) was compared with that in younger patients (aged 18-64 years).Main MeasuresModel discrimination (as defined by the c-statistic) and calibration (as defined by the Hosmer-Lemeshow P value).ResultsCRASH-CT model discrimination was not significantly different between the older (n = 356; weighted n = 524) and younger patients (n = 981; weighted n = 2602) and was generally adequate (c-statistic 0.83 vs 0.87, respectively; P = .11). CRASH-CT model calibration was adequate for the older patients and inadequate for younger patients (Hosmer-Lemeshow P values .12 and .001, respectively), possibly reflecting differences in sample size. Calibration-in-the-large showed no systematic under- or overprediction in either stratum.ConclusionThe CRASH-CT model may be valid for use in a geriatric population.

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