title: Helsinki Computed Tomography Scoring System Can Independently Predict Long-Term Outcome in Traumatic Brain Injury.
abstract: OBJECTIVE
  The Helsinki computed tomography (CT) scoring system was developed to predict long-term outcome in patients with traumatic brain injury (TBI) 2 years ago; however, it has not yet been external validated. This study aimed to determine whether this system could be used as an independent predictor for TBI.
  
  
  METHODS
  This retrospective cohort study was performed on 302 consecutive patients with TBI. Univariate and multivariate logistic regressions and receiver operating characteristic curve analyses were used to determine the relationship between initial Helsinki CT scores and mortality and unfavorable neurologic outcome at 6 months after injury. Outcomes were assessed using the Glasgow Outcome Scale (scores of 1-3 defined as unfavorable outcome).
  
  
  RESULTS
  Of all patients, mortality was 17.9% and unfavorable outcome was 41.4%. The Helsinki CT score was significantly associated with the 6-month outcome in univariate analyses (P < 0.05). After adjustment for other factors in the multivariate regression analysis, the Helsinki CT score remained an independent predictor for mortality (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.08-1.39; P = 0.002) and unfavorable outcome (OR, 1.14; 95% CI, 1.04-1.26; P = 0.007). Receiver operating characteristic curve analyses showed that the Helsinki CT score possessed good discrimination ability for mortality (area under the curve, 0.81; 95% CI, 0.75-0.87; P < 0.001) and moderate discrimination ability for unfavorable outcome (area under the curve, 0.74; 95% CI, 0.69-0.80; P < 0.001). Moreover, at 1.9 hours after TBI, the Helsinki CT score was most accurate for predicting mortality (accuracy, 74.5%) and unfavorable outcome (accuracy, 71.5%).
  
  
  CONCLUSIONS
  The Helsinki CT score showed good prognostic discrimination and can be used as an independent predictor for long-term outcome prediction in patients with TBI.
authors.affiliation: Department of Neurosurgery, Wuhan General Hospital of PLA, Hubei Province, PR China; Department of Neurosurgery, Wuhan General Hospital of PLA, Southern Medical University, Guangzhou, Guangdong Province, PR China.
authors.forename: Shun
authors.initials: S
authors.lastname: Yao
authors.affiliation: Department of Neurosurgery, Wuhan General Hospital of PLA, Hubei Province, PR China.
authors.forename: Jian
authors.initials: J
authors.lastname: Song
authors.affiliation: Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, PR China.
authors.forename: Shun
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Wuhan General Hospital of PLA, Southern Medical University, Guangzhou, Guangdong Province, PR China.
authors.forename: Chenglong
authors.initials: C
authors.lastname: Cao
authors.affiliation: Department of Neurosurgery, Wuhan General Hospital of PLA, Hubei Province, PR China.
authors.forename: Li
authors.initials: L
authors.lastname: Fang
authors.affiliation: Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, PR China.
authors.forename: Chaohu
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Wuhan General Hospital of PLA, Hubei Province, PR China; Department of Neurosurgery, Wuhan General Hospital of PLA, Southern Medical University, Guangzhou, Guangdong Province, PR China. Electronic address: yaoshun2008@yeah.net.
authors.forename: Guozheng
authors.initials: G
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000401:mortality* / Q000592:standards*
keywords: Computed tomography; Helsinki CT score; Long-term outcome prediction; Traumatic brain injury