Development and internal validation of the goliat score to predict 48-hour complications after minor/moderate traumatic brain injury in the emergency department: a single-center cohort study
Dublin Core
Title
Development and internal validation of the goliat score to predict 48-hour complications after minor/moderate traumatic brain injury in the emergency department: a single-center cohort study
Subject
Traumatic brain injury, Emergency department, Risk stratification, Clinical prediction, Elderly people
Description
Background Most patients with non-severe traumatic brain injury (TBI) do not develop complications after 24 h
of hospital observation. Identifying low-risk patients could enable safe discharge and follow-up—potentially via
telemedicine—while avoiding unnecessary cranial CT scans, particularly in older adults.
Methods We performed a single-centre, consecutive cohort study (tertiary ED, Spain; 1 June 2019–31 December
2020). Adults with minor/moderate TBI (GCS 13–15) were included. The primary outcome was any clinically relevant
complication within 48 h (neurological, cardiorespiratory, or death), ascertained by a structured 48-h telephone
follow-up plus electronic health record review by assessors independent from clinical care. Candidate predictors
(≤6 h) comprised baseline factors (age, sex, Charlson comorbidity index, prior anticoagulation), injury-severity signals
(polytrauma-code activation, pupil abnormality, fluctuating GCS), physiology/haematology (systolic blood pressure,
platelet count), and serum S100 (<6 h). A multivariable logistic regression with prespecified functional forms (splines/
transforms) and two interactions (sex×log[S100]; hypertension×SBP) was fitted. Internal validation used bootstrap/
LOOCV with optimism correction and uniform shrinkage. Performance was assessed by AUC, Brier score, calibration
(slope/intercept, plots), and decision-curve analysis (DCA). We defined a risk-stratified pathway at ~6 h (discharge vs.
short observation vs. admission).
Results Median age was 84 years (IQR 73–88), and 84.6% were ≥65 years. Acute complications occurred in
155 patients (29.5%). Independent predictors were age, sex, platelet count, systolic blood pressure, history of
hypertension, S100B level at 6 h, anticoagulant treatment, and any high-risk clinical event (fluctuating GCS, moderate
severity, pupil alteration, TBI code activation, anticoagulant reversal, polytrauma). Pathological CT findings did not
show a significant contribution to the predictive model (LRT p=0.10) and were not used. The Goliat score achieved an
of hospital observation. Identifying low-risk patients could enable safe discharge and follow-up—potentially via
telemedicine—while avoiding unnecessary cranial CT scans, particularly in older adults.
Methods We performed a single-centre, consecutive cohort study (tertiary ED, Spain; 1 June 2019–31 December
2020). Adults with minor/moderate TBI (GCS 13–15) were included. The primary outcome was any clinically relevant
complication within 48 h (neurological, cardiorespiratory, or death), ascertained by a structured 48-h telephone
follow-up plus electronic health record review by assessors independent from clinical care. Candidate predictors
(≤6 h) comprised baseline factors (age, sex, Charlson comorbidity index, prior anticoagulation), injury-severity signals
(polytrauma-code activation, pupil abnormality, fluctuating GCS), physiology/haematology (systolic blood pressure,
platelet count), and serum S100 (<6 h). A multivariable logistic regression with prespecified functional forms (splines/
transforms) and two interactions (sex×log[S100]; hypertension×SBP) was fitted. Internal validation used bootstrap/
LOOCV with optimism correction and uniform shrinkage. Performance was assessed by AUC, Brier score, calibration
(slope/intercept, plots), and decision-curve analysis (DCA). We defined a risk-stratified pathway at ~6 h (discharge vs.
short observation vs. admission).
Results Median age was 84 years (IQR 73–88), and 84.6% were ≥65 years. Acute complications occurred in
155 patients (29.5%). Independent predictors were age, sex, platelet count, systolic blood pressure, history of
hypertension, S100B level at 6 h, anticoagulant treatment, and any high-risk clinical event (fluctuating GCS, moderate
severity, pupil alteration, TBI code activation, anticoagulant reversal, polytrauma). Pathological CT findings did not
show a significant contribution to the predictive model (LRT p=0.10) and were not used. The Goliat score achieved an
Creator
Oriol Yuguero1,2,3*, Itziar López-Vena1
, Montserrat Martinez-Alonso2,4, Ana Vena1,2, Maria Bernal5
and
Francisco Purroy2,6
, Montserrat Martinez-Alonso2,4, Ana Vena1,2, Maria Bernal5
and
Francisco Purroy2,6
Source
https://doi.org/10.1186/s12873-025-01457-9
Date
2026
Contributor
PERI IRAWAN
Format
PDF
Language
ENGLISH
Type
TEXT
Files
Collection
Citation
Oriol Yuguero1,2,3*, Itziar López-Vena1
, Montserrat Martinez-Alonso2,4, Ana Vena1,2, Maria Bernal5
and
Francisco Purroy2,6, “Development and internal validation of the goliat score to predict 48-hour complications after minor/moderate traumatic brain injury in the emergency department: a single-center cohort study,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12057.