{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:16:36Z","timestamp":1783433796707,"version":"3.54.6"},"reference-count":35,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>While most people fully recover after mild traumatic brain injury (mTBI), a substantial minority experience persistent symptoms and incomplete recovery. This may be prevented by early interventions specifically targeting patients at risk of incomplete recovery. The UPFRONT\u2010model was developed to identify patients at risk of poor functional outcome. This study aimed to externally validate the UPFRONT\u2010model in an independent sample.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective, longitudinal, multicenter cohort study with 126 mTBI patients recruited from emergency and neurology departments (ED) of six hospitals in the Netherlands was performed. Predictors in the UPFRONT\u2010model included educational level, Glasgow Coma Scale (GCS), neck pain at injury, alcohol intoxication, Post Traumatic Amnesia (PTA), pre\u2010injury mental health, anxiety, depression, coping, and the number and severity of post\u2010traumatic complaints. Functional recovery at 6\u2009months was assessed using the Glasgow Outcome Scale Extended (GOS\u2010E). The external validity of the UPRFONT model was assessed with measures of calibration and discrimination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The model showed acceptable discriminative ability (AUC\u2009=\u20090.74), comparable to the development sample (AUC\u2009=\u20090.77). However, calibration revealed systematic underestimation of recovery (predicted: 46%; observed: 75%), with a calibration intercept of 1.52 and a slope of 0.70. Despite differences in some predictor effects, psychological variables were robust and consistent across samples.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The UPFRONT\u2010model demonstrated solid discriminative performance in an external cohort, but tended to underestimate the likelihood of complete recovery. Further validation and optimization are needed before clinical implementation. The model holds promise for early identification of at\u2010risk patients, enabling targeted interventions following mTBI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ene.70626","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T10:14:08Z","timestamp":1781864048000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["External Validation of a Prognostic Model for Outcome After Mild Traumatic Brain Injury at 6\u2009Months Post Injury"],"prefix":"10.1111","volume":"33","author":[{"given":"Robin","family":"van Pinxteren","sequence":"first","affiliation":[{"name":"Department of Medical Psychology VieCuri Medical Center  Venlo the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2711-3131","authenticated-orcid":false,"given":"Marilien C.","family":"Marzolla","sequence":"additional","affiliation":[{"name":"Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience Maastricht University  Maastricht the Netherlands"},{"name":"Limburg Brain Injury Center  Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8059-4747","authenticated-orcid":false,"given":"Melloney L. M.","family":"Wijenberg","sequence":"additional","affiliation":[{"name":"Adelante, Center of Expertise in Rehabilitation and Audiology  Hoensbroek the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4272-7315","authenticated-orcid":false,"given":"Caroline M.","family":"van Heugten","sequence":"additional","affiliation":[{"name":"Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience Maastricht University  Maastricht the Netherlands"},{"name":"Limburg Brain Injury Center  Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4329-2560","authenticated-orcid":false,"given":"Frits H. M.","family":"van Osch","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology VieCuri Medical Center  Venlo the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9873-2418","authenticated-orcid":false,"given":"Joukje","family":"van der Naalt","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Groningen, University Medical Center Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6477-0763","authenticated-orcid":false,"given":"Jacoba M.","family":"Spikman","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Groningen, University Medical Center Groningen  Groningen the Netherlands"},{"name":"Department of Clinical Neuropsychology University of Groningen, University Medical Center Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1579-6964","authenticated-orcid":false,"given":"Marieke E.","family":"Timmerman","sequence":"additional","affiliation":[{"name":"Department of Psychometrics and Statistics University of Groningen, University Medical Center Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3729-229X","authenticated-orcid":false,"given":"Jeroen J.","family":"Roor","sequence":"additional","affiliation":[{"name":"Department of Medical Psychology VieCuri Medical Center  Venlo the Netherlands"},{"name":"School for Mental Health and Neuroscience Maastricht University  Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0191655"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2011.03590.x"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/16501960410023732"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2013.08.299"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-006-0156-5"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/HTR.0b013e3182915cb5"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-020-10385-6"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.2217\/cnc-2019-0011"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2005.07.018"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30117-5"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2007.131250"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30371-X"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(25)00154-1"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2009.1059"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2014.3384"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2023.0302"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2014.3600"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.44.4.285"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.1998.15.573"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfaa188"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-0698"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2020.7074"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2024.0610"},{"key":"e_1_2_12_25_1","volume-title":"Het Coderen Van Het Opleidingsniveau Voor Researchdoeleinden","author":"Verhage F.","year":"1983"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/03331024111430856"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1983.tb09716.x"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2008.06.007"},{"key":"e_1_2_12_29_1","volume-title":"De Utrechtse Coping Lijst: UCL. Handleiding","author":"Schreurs P.","year":"1993"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00868811"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1191\/0269215505cr905oa"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.3171\/foc.2002.13.1.6"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-019-1466-7"},{"key":"e_1_2_12_34_1","unstructured":"Specialisten F.M \u201cRichtlijn Aanhoudende Klachten Na Licht Traumatisch Hoofd\/Hersenletsel \u201d(2024)."},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2016.4885"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/HTR.0000000000000931"}],"container-title":["European Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ene.70626","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ene.70626","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ene.70626","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:37:07Z","timestamp":1783431427000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ene.70626"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":35,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/ene.70626"],"URL":"https:\/\/doi.org\/10.1111\/ene.70626","archive":["Portico"],"relation":{},"ISSN":["1351-5101","1468-1331"],"issn-type":[{"value":"1351-5101","type":"print"},{"value":"1468-1331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2025-07-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70626"}}