title: Dynamics of brain tissue changes induced by traumatic brain injury assessed with the Marshall, Morris-Marshall, and the Rotterdam classifications and its impact on outcome in a prostacyclin placebo-controlled study.
abstract: BACKGROUND
  The present study evaluates the types and dynamics of intracranial pathological changes in patients with severe traumatic brain injury (sTBI) who participated in a prospective, randomized, double-blinded study of add-on treatment with prostacyclin. Further, the changes of brain CT scan and their correlation to Glasgow Coma Scale score (GCS), maximal intracranial pressure (ICP(max)), minimal cerebral perfusion pressure (CPP(min)), and Glasgow Outcome Score (GOS) at 3, 6, and 12 months were studied.
  
  
  METHODS
  Forty-eight subjects with severe traumatic brain injury were treated according to an ICP-targeted therapy protocol based on the Lund concept with the addition of prostacyclin or placebo. The first available CT scans (CT(i)) and follow-up scans nearest to 24 h (CT(24)) were evaluated using the Marshall, Rotterdam, and Morris-Marshall classifications.
  
  
  RESULTS
  There was a significant correlation of the initial Marshall, Rotterdam, Morris-Marshall classifications and GOS at 3 and 12 months. The CT(24) Marshall classification did not significantly correlate to GOS while the Rotterdam and the Morris-Marshall classification did. The CT(i) Rotterdam classification predicted outcome evaluated as GOS at 3 and 12 months. Prostacyclin treatment did not influence the dynamic of tissue changes.
  
  
  CONCLUSIONS
  The Rotterdam classification seems to be appropriate for describing the evolution of the injuries on the CT scans and contributes in predicting of outcome in patients treated with an ICP-targeted therapy. The Morris-Marshall classification can also be used for prognostication of outcome but it describes only the impact of traumatic subarachnoid hemorrhage (tSAH).
authors.affiliation: Department of Pharmacology and Clinical Neuroscience, Division of Neurosurgery, Umeå University, Sweden. lukasbobinski@yahoo.com
authors.forename: Lukas
authors.initials: L
authors.lastname: Bobinski
authors.forename: Magnus
authors.initials: M
authors.lastname: Olivecrona
authors.forename: Lars-Owe D
authors.initials: LO
authors.lastname: Koskinen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D001930:Brain Injuries / Q000145:classification* / Q000150:complications / Q000175:diagnosis*; D011464:Epoprostenol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011379:Prognosis; D011446:Prospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D011464:Epoprostenol