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  • Comparison of Predictability of Marshall, Rotterdam and Helsinki CT Scan Scoring System in Determining Early Mortality After Traumatic Brain Injury

    Final Number:

    Sebastian Serrano; Jose D Charry MS; Juan D. Areiza; Miguel A. Pinzon; Jorman H. Tejada; Juan Pablo Solano MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Traumatic Brain Injury (TBI) is a public health problem. It is a pathology that causes significant mortality and disability. Different models have been developed in order to predict the neurological outcomes. Marshall computed tomographic (CT) classification is widely used as a predictor of mortality. However, this grading system lacks useful variables to predict the outcome of the patient, which are subarachnoid/intraventricular hemorrhage, extradural hematoma, and extent of basal cistern compression. Newer classifications like Rotterdam and Helsinki CT scores include the above variables and seem to be very similar, however these classifications have not been validated widely. We aimed to compare the discriminatory and prediction power of all the grading systems and it correlation with mortality in a university hospital in Colombia.

    Methods: This is a retrospective study of patients with moderate and severe TBI (Glasgow coma scale (GCS) 3–12) who presented to our hospital. All the patients were followed up for 6 month to determine early mortality and neurological unfavorable outcome. The Behavior and mortality prediction power of each grading system was determined using the Spearman's rank correlation coefficient and the area under the receiver operating characteristic curve (AUC).

    Results: A total of 145 patients were enrolled in the study, median age 33 (15-85) years, and 86.89% were male. The overall mortality was 24.83%. The median GCS of patients was 6 (3-12). There was low correlation between the models and mortality (Spearman's rho < 0.40). The Marshall CT and CT Helsinki classifications tended to overestimate and underestimate mortality and had reasonable and good discrimination (AUC - 0.646 and 0.724). Rotterdam grading had the best correlation and discrimination (Spearman's rho: 0.355 and AUC - 0.735).

    Conclusions: Rotterdam and Helsinki classification systems are good in predicting early mortality after moderate and severe TBI at 6 months, however Rotterdam show the best prediction power

    Patient Care: using the CT scores we can improve the outcome of patients with TBI

    Learning Objectives: By the conclusion of this session, participants should be able to: learn and aplied the CT scores in order to improve the outcome ofe the patients with TBI

    References: 1. Munakomi S, Bhattarai B, Srinivas B, Cherian I. Role of computed tomography scores and findings to predict early death in patients with traumatic brain injury: A reappraisal in a major tertiary care hospital in Nepal.Surg Neurol Int. 2016 Feb 19;7:23. 2. Raj R, Siironen J, Skrifvars MB, Hernesniemi J, Kivisaari R.Predicting outcome in traumatic brain injury: development of a novel computerized tomography classification system (Helsinki computerized tomography score).Neurosurgery. 2014 Dec;75(6):632-46; 3. Liesemer K, Riva-Cambrin J, Bennett KS, Bratton SL, Tran H, Metzger RR,ET AL. Use of Rotterdam CT scores for mortality risk stratification in children with traumatic brain injury. Pediatr Crit Care Med. 2014 Jul;15(6):554-62

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