title: Predicting outcomes of decompressive craniectomy: use of Rotterdam Computed Tomography Classification and Marshall Classification.
abstract: BACKGROUND
  Data on the evaluation of the Rotterdam Computed Tomography Classification (RCTS) as a predictor of outcomes in patients undergoing decompressive craniectomy (DC) for trauma is limited and lacks clarity.
  
  
  OBJECTIVE
  To explore the role of RCTS in predicting unfavourable outcomes, including mortality in patients undergoing DC for head trauma.
  
  
  METHODS
  This was an observational cohort study conducted from 1 January 2009 to 31 March 2013. CT scans of adults with head trauma prior to emergency DC were scored according to RCTS. A receiver operating characteristic curve analysis was performed to identify the optimal cut-off RCTS for predicting unfavourable outcomes [Glasgow outcome scale (GOS) = 1-3]. Binary logistic regression analysis was performed to evaluate the relationship between RCTS and unfavourable outcomes including mortality.
  
  
  RESULTS
  One hundred ninety-seven patients (mean age: 31.4 ± 18.7 years) were included in the study. Mean Glasgow coma score at presentation was 8.1 ± 3.6. RCTS was negatively correlated with GOS (r = -0.370; p < 0.001). The area under the curve was 0.687 (95% CI: 0.595-0.779; p < 0.001) and 0.666 (95% CI: 0.589-0.742; p < 0.001) for mortality and unfavourable outcomes, respectively. RCTS independently predicted both mortality (adjusted odds ratio for RCTS >3 compared with RCTS ≤3: 2.792, 95% CI: 1.235-6.311) and other unfavourable outcomes (adjusted odds ratio for RCTS >3 compared with RCTS ≤3: 2.063, 95% CI: 1.056-4.031).
  
  
  CONCLUSIONS
  RCTS is an independent predictor of unfavourable outcomes and mortality among patients undergoing emergency DC.
authors.affiliation: a Department of Surgery, Section of Neurosurgery , Aga Khan University Hospital , Karachi , Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Waqas
authors.affiliation: a Department of Surgery, Section of Neurosurgery , Aga Khan University Hospital , Karachi , Pakistan.
authors.forename: Muhammad Shahzad
authors.initials: MS
authors.lastname: Shamim
authors.affiliation: a Department of Surgery, Section of Neurosurgery , Aga Khan University Hospital , Karachi , Pakistan.
authors.forename: Syed Faaiz
authors.initials: SF
authors.lastname: Enam
authors.affiliation: a Department of Surgery, Section of Neurosurgery , Aga Khan University Hospital , Karachi , Pakistan.
authors.forename: Mohsin
authors.initials: M
authors.lastname: Qadeer
authors.affiliation: a Department of Surgery, Section of Neurosurgery , Aga Khan University Hospital , Karachi , Pakistan.
authors.forename: Saqib Kamran
authors.initials: SK
authors.lastname: Bakhshi
authors.affiliation: a Department of Surgery, Section of Neurosurgery , Aga Khan University Hospital , Karachi , Pakistan.
authors.forename: Iqra
authors.initials: I
authors.lastname: Patoli
authors.affiliation: a Department of Surgery, Section of Neurosurgery , Aga Khan University Hospital , Karachi , Pakistan.
authors.forename: Khabir
authors.initials: K
authors.lastname: Ahmad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D056424:Decompressive Craniectomy / Q000379:methods / Q000401:mortality*; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: Decompressive craniectomy; Glasgow outcome scale; Rotterdam Classification; traumatic brain injury; unfavourable outcomes