title: Use of Rotterdam CT scores for mortality risk stratification in children with traumatic brain injury.
abstract: OBJECTIVE
  The Rotterdam CT score refined features of the Marshall score and was designed to categorize traumatic brain injury type and severity in adults. The objective of this study was to determine whether the Rotterdam CT score can be used for mortality risk stratification after pediatric traumatic brain injury.
  
  
  METHODS
  In children with moderate to severe traumatic brain injury, a comparison of observed versus predicted mortality was calculated using published model probabilities of adult mortality. Development and validation of a new pediatric mortality model using randomly selected prediction and validation samples from our cohort.
  
  
  METHODS
  A single level 1 pediatric trauma center.
  
  
  METHODS
  Six hundred thirty-two children with moderate or severe traumatic brain injury.
  
  
  METHODS
  None.
  
  
  RESULTS
  Sixteen percent of the patients (101 of 632) died prior to hospital discharge. The predicted mortality based on Rotterdam score for adults with moderate or severe traumatic brain injury discriminated pediatric observed mortality well (area under the curve = 0.85; 95% CI, 0.80-0.89) but had poor calibration, overestimating or underestimating mortality for children in several Rotterdam categories. A predictive model based on children with moderate or severe traumatic brain injury from the single center discriminated mortality well (area under the curve, 0.80; 95% CI, 0.68-0.91) and showed good calibration and overall fit.
  
  
  CONCLUSIONS
  Children with traumatic brain injury have better survival than adults in Rotterdam CT score categories representing less severe injuries but worse survival than adults in higher score categories. A novel, validated pediatric mortality model based on the Rotterdam score is accurate in children with moderate or severe traumatic brain injury and can be used for risk stratification.
authors.affiliation: 1Pediatric Critical Care, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, UT. 2Pediatric Neurosurgery, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, UT. 3Emergency Medicine, University of Rochester School of Medicine, Rochester, NY. 4Pediatric Surgery, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, UT.
authors.forename: Kate
authors.initials: K
authors.lastname: Liesemer
authors.forename: Jay
authors.initials: J
authors.lastname: Riva-Cambrin
authors.forename: Kimberly Statler
authors.initials: KS
authors.lastname: Bennett
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
authors.forename: Henry
authors.initials: H
authors.lastname: Tran
authors.forename: Ryan R
authors.initials: RR
authors.lastname: Metzger
authors.forename: Tellen D
authors.initials: TD
authors.lastname: Bennett
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D001930:Brain Injuries / Q000145:classification / Q000000981:diagnostic imaging* / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D015233:Models, Statistical; D012372:ROC Curve; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices
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