Assessment of Rotterdam Vs Marshall CT Grading for Prognosis of Head Injury

Abstract

Trauma is one of the most important issues of most healthcare systems accompanying with head trauma in

the most cases. We sought to determine the scoring system and initial Computed Tomography (CT) findings

predicting the death at hospital discharge (early death) in patients with traumatic brain injury based on

Marshall and Rotterdam CT scores. This is a cross sectional study on traumatic neurosurgical patients with

mild-to-severe traumatic brain injury admitted to the emergency department of neurosurgery shyam shah

medical college,rewa. Patients?18 years old with TBI during last 24 hours with GCS?13 were included

and exclusion criteria were multiple trauma, penetrating injuries, previous history of anticoagulant therapy,

pregnancy, not willingness for participation. Their initial CT and status at hospital discharge, one and three

months (dead or alive) were reviewed, and both CT scores were calculated. We examined whether each score

is related to death using SPSS11 by The Mann–Whitney U at the level of p?0.05. Overall, 98 patients were

included. Mean age was 43.52±21.29. Most patients were male (63.3%). Mean Marshall and Rotterdam CT

scores were 3.2±1.3 and 2.5±1. The mortality at two weeks, one moth and three months were 19.4%, 20.4%,

and 20.4%. Rotterdam CT score was significantly different based on type of hematoma. Median GCS score

in alive and dead patients on 2 weeks were 10 and 4 (p=0.0001), at one month were 10 and 4 (p=0.0001),

and at three months were 10 and 4 (p=0.0001). The median Marshall CT score on 2 weeks were 2 and 4

(p=0.0001), at one month were 2 and 4 (p=0.0001), and at three months were 2 and 4 (p=0.0001). The

median Rotterdam CT score on 2 weeks were 2 and 4 (p=0.0001), at one month were 2 and 3 (p=0.001), and

at three months were 2 and 3 (p=0.001). The Rotterdam CT score was significantly correlated with mortality

at two weeks, one month and three months (p=0.004, p=0.001, and p=0.001, respectively). The Marshall

CT score was not significantly correlated with mortality at any time. The Rotterdam CT score was more

accurate for prediction of mortality on 2 weeks (ROC80.9), at one month (ROC80.7), and at three months

were (ROC80.7) than The Rotterdam CT score (ROC 76, 74.1, and 74.1, respectively). This study concluded

that The Marshall CT score was more accurate for prediction of mortality on 2 weeks, at one month, and at

three months were than The Marshall CT score with higher ROC. The correlation of the Rotterdam CT score

with mortality was significant