title: Predicting outcome in traumatic brain injury: development of a novel computerized tomography classification system (Helsinki computerized tomography score).
abstract: BACKGROUND
  Early computerized tomography (CT) abnormalities are important predictors of outcome after traumatic brain injury (TBI).
  
  
  OBJECTIVE
  To develop a novel CT scoring system (Helsinki CT score) and to compare it with the Marshall CT classification and the Rotterdam CT score in predicting long-term outcome of patients with TBI.
  
  
  METHODS
  Eight hundred sixty-nine consecutive TBI patients were included in this open-cohort, retrospective, single-center study. Logistic regression was used to develop the Helsinki CT score. The scores from the Marshall, Rotterdam, and Helsinki CT scoring methods were added to a clinical model based on age, motor score, and pupils to evaluate their value in predicting outcome. Internal validity was assessed by a bootstrap technique and expressed as area under the curve (AUC). Outcome was 6-month unfavorable neurological outcome and mortality.
  
  
  RESULTS
  Variables included in the Helsinki CT score were bleeding type and size, intraventricular hemorrhage, and suprasellar cisterns. In the present data set, the performance of the Helsinki CT score was superior to that of the Marshall CT and Rotterdam CT scores (AUC, 0.74-0.75 vs 0.63-0.70; P < .001). Addition of the Helsinki CT score modestly increased prognostic performance of the clinical model (AUC neurological outcome +0.02 [P = .002]; AUC mortality, +0.01 [P = .21]). In contrast, the Marshall and Rotterdam CT scores were of no additional predictive value to the clinical model (P > .05).
  
  
  CONCLUSIONS
  Use of the novel Helsinki CT score improved outcome prediction accuracy, and the Helsinki CT score is a feasible alternative to the Rotterdam and Marshall CT systems. External validation of the Helsinki CT score is advocated to show generalizability.
authors.affiliation: *Departments of Neurosurgery and ‡Intensive Care, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Rahul
authors.initials: R
authors.lastname: Raj
authors.forename: Jari
authors.initials: J
authors.lastname: Siironen
authors.forename: Markus B
authors.initials: MB
authors.lastname: Skrifvars
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
authors.forename: Riku
authors.initials: R
authors.lastname: Kivisaari
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001930:Brain Injuries / Q000145:classification* / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed