Update: Traumatic brain injury CT Classification

Traumatic brain injury CT Classification

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.

Both Marshall and Rotterdam grading systems are good in predicting early mortality after moderate and severe TBI 1).

As the Rotterdam system also includes additional variables like subarachnoid hemorrhage, it may be preferable, particularly in patients with diffuse injury 2).

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 3).

Marshall CT classification

Rotterdam CT score

The Rotterdam CT score refined features of the Marshall score and was designed to categorize traumatic brain injury type and severity in adults. The score was developed for prognostic purposes.

The Rotterdam CT score provides great prognostic discrimination and is an independent predictor of unfavorable outcomes. Huang et al. suggest that the Rotterdam CT score be included as a prognosticator in the overall assessment of clinical condition of TBI patients before decompressive craniectomy (DC) 4).

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 5).

see Rotterdam CT score

Helsinki CT score

1) Mata-Mbemba D, Mugikura S, Nakagawa A, Murata T, Ishii K, Li L, Takase K, Kushimoto S, Takahashi S. Early CT findings to predict early death in patients with traumatic brain injury: Marshall and Rotterdam CT scoring systems compared in the major academic tertiary care hospital in northeastern Japan. Acad Radiol. 2014 May;21(5):605-11. doi: 10.1016/j.acra.2014.01.017. PubMed PMID: 24703472.
2) Deepika A, Prabhuraj AR, Saikia A, Shukla D. Comparison of predictability of Marshall and Rotterdam CT scan scoring system in determining early mortality after traumatic brain injury. Acta Neurochir (Wien). 2015 Sep 15. [Epub ahead of print] PubMed PMID: 26374440.
3) Raj R, Siironen J, Skrifvars MB, Hernesniemi J, Kivisaari R. Predicting outcome in traumatic brain injury: development of a novel computerized tomography classification system (Helsinki computerized tomography score). Neurosurgery. 2014 Dec;75(6):632-46; discussion 646-7. doi: 10.1227/NEU.0000000000000533. PubMed PMID: 25181434.
4) Huang YH, Deng YH, Lee TC, Chen WF. Rotterdam computed tomography score as a prognosticator in head-injured patients undergoing decompressive craniectomy. Neurosurgery. 2012 Jul;71(1):80-5. doi: 10.1227/NEU.0b013e3182517aa1. PubMed PMID: 22382208.
5) Liesemer K, Riva-Cambrin J, Bennett KS, Bratton SL, Tran H, Metzger RR, Bennett TD. Use of Rotterdam CT scores for mortality risk stratification in children with traumatic brain injury. Pediatr Crit Care Med. 2014 Jul;15(6):554-62. doi: 10.1097/PCC.0000000000000150. PubMed PMID: 24751786; PubMed Central PMCID: PMC4087067.

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