Papers › The leap to ordinal: detailed functional prognosis after traumatic brain injury with a...
The leap to ordinal: detailed functional prognosis after traumatic brain injury with a flexible modelling approach
Shubhayu Bhattacharyay, Ioan Milosevic, Lindsay Wilson, David K. Menon, Robert D. Stevens, Ewout W. Steyerberg, David W. Nelson, Ari Ercole, the CENTER-TBI investigators/participants
When a patient is admitted to the intensive care unit (ICU) after a traumatic brain injury (TBI), an early prognosis is essential for baseline risk adjustment and shared decision making. TBI outcomes are commonly categorised by the Glasgow Outcome Scale-Extended (GOSE) into 8, ordered levels of functional recovery at 6 months after injury. Existing ICU prognostic models predict binary outcomes at a certain threshold of GOSE (e.g., prediction of survival [GOSE>1] or functional independence [GOSE>4]). We aimed to develop ordinal prediction models that concurrently predict probabilities of each GOSE score. From a prospective cohort (n=1,550, 65 centres) in the ICU stratum of the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) patient dataset, we extracted all clinical information within 24 hours of ICU admission (1,151 predictors) and 6-month GOSE scores. We analysed the effect of 2 design elements on ordinal model performance: (1) the baseline predictor set, ranging from a concise set of 10 validated predictors to a token-embedded representation of all possible predictors, and (2) the modelling strategy, from ordinal logistic regression to multinomial deep learning. With repeated k-fold cross-validation, we found that expanding the baseline predictor set significantly improved ordinal prediction performance while increasing analytical complexity did not. Half of these gains could be achieved with the addition of 8 high-impact predictors (2 demographic variables, 4 protein biomarkers, and 2 severity assessments) to the concise set. At best, ordinal models achieved 0.76 (95% CI: 0.74-0.77) ordinal discrimination ability (ordinal c-index) and 57% (95% CI: 54%-60%) explanation of ordinal variation in 6-month GOSE (Somers' D). Our results motivate the search for informative predictors for higher GOSE and the development of ordinal dynamic prediction models.
Code
Repository list and official/mentioned flags are the archive's, frozen 2025-07-28. Reachability, where shown, is from one Syntology probe window (2026-09-16 to 2026-09-18); repositories not probed show nothing. GitHub stars are not tracked.
Code Syntology ran Syntology
Not run by Syntology. Nothing on this page verifies that the listed code works.
Tasks
Datasets
Introduced by this paper, per the archive.
Results from the paper archive 2025-07-28
No leaderboard rows for this paper in the archive.
Methods
Report a problem or propose a change · a person checks every report against the paper or source before anything changes; decisions are listed on /corrections