Early CT findings to predict early death in patients with traumatic brain injury: Marshall and Rotterdam CT scoring systems compared in the major academic tertiary care hospital in northeastern Japan.
OBJECTIVE
Computed tomography (CT) plays a crucial role in early assessment of patients with traumatic brain injury (TBI). Marshall and Rotterdam are the mostly used scoring systems, in which CT findings are grouped differently. We sought to determine the scoring system and initial CT findings predicting the death at hospital discharge (early death) in patients with TBI.


METHODS
We included 245 consecutive adult patients with mild-to-severe TBI. Their initial CT and status at hospital discharge (dead or alive) were reviewed, and both CT scores were calculated. We examined whether each score was related to early death; compared the two scoring systems' performance in predicting early death, and identified the CT findings that are independent predictors of early death.


RESULTS
More deaths occurred among patients with higher Marshall and Rotterdam scores (both P < .05, Mann-Whitney U test). The areas under the receiver operating characteristic curve (AUCs) indicated that both scoring systems had similarly good discriminative power in predicting early death (Marshall, AUC = 0. 85 vs. Rotterdam, AUC = 0.85). Basal cistern absence (odds ratio [OR] = 771.5, P < .0001), positive midline shift (OR = 56.2, P = .0011), hemorrhagic mass volume ≥25 mL (OR = 12.9, P = .0065), and intraventricular or subarachnoid hemorrhage (OR = 3.8, P = .0395) were independent predictors of early death.


CONCLUSIONS
Both Marshall and Rotterdam scoring systems can be used to predict early death in patients with TBI. The performance of the Marshall score is at least equal to that of the Rotterdam score. Thus, although older, the Marshall score remains useful in predicting patients' prognosis.
Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan.
Daddy
D
Mata-Mbemba
Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan. Electronic address: mugi@rad.med.tohoku.ac.jp.
Shunji
S
Mugikura
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Atsuhiro
A
Nakagawa
Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan.
Takaki
T
Murata
Department of Radiology, Sendai City Hospital, Sendai, Japan.
Kiyoshi
K
Ishii
Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan.
Li
L
Li
Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan.
Kei
K
Takase
Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Shigeki
S
Kushimoto
Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan.
Shoki
S
Takahashi
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000401:mortality*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D015996:Survival Rate; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
CT; Marshall; Rotterdam; early death; traumatic brain injury