title: Comparison of predictability of Marshall and Rotterdam CT scan scoring system in determining early mortality after traumatic brain injury.
abstract: BACKGROUND
  Marshall computed tomographic (CT) classification is widely used as a predictor of outcome. However, this grading system lacks the following variables, which are found to be useful predictors: subarachnoid/intraventricular hemorrhage, extradural hematoma, and extent of basal cistern compression. A new classification called the Rotterdam grading system, incorporating the above variables, was proposed later. In the original paper, this system was found to have superior discrimination as compared to Marshall grading, however, Rotterdam grading has not been validated widely. We aimed to compare the discriminatory power of both grading systems.
  
  
  METHODS
  This is a prospective study of patients with moderate and severe TBI (Glasgow coma scale (GCS) 3-12) who presented to our casualty. All the patients were followed up for 2 weeks to determine early mortality. The discriminatory power of each grading system was determined using area under the receiver operating characteristic curve (AUC).
  
  
  RESULTS
  A total of 134 patients, mean age 38.3 (±15.7) years, were recruited for study. The overall mortality was 11.2 %. The mean GCS of these patients was 9.6 (±2.3). There was good correlation between Marshall and Rotterdam grading, r = 0.68 (significant at 0.01 level). The Marshall CT classification had reasonable discrimination (AUC - 0.707), and Rotterdam grading had good discrimination (AUC - 0.681).
  
  
  CONCLUSIONS
  Both Marshal and Rotterdam grading systems are good in predicting early mortality after moderate and severe TBI. As the Rotterdam system also includes additional variables like subarachnoid hemorrhage, it may be preferable, particularly in patients with diffuse injury.
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India.
authors.forename: Akhil
authors.initials: A
authors.lastname: Deepika
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India.
authors.forename: A R
authors.initials: AR
authors.lastname: Prabhuraj
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India.
authors.forename: Amrit
authors.initials: A
authors.lastname: Saikia
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India. neurodhaval@rediffmail.com.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Shukla
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000145:classification / Q000000981:diagnostic imaging* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D015599:Trauma Severity Indices; D055815:Young Adult
keywords: Marshall CT scan classification; Rotterdam CT scan score; Traumatic brain injury