Izvorni znanstveni članak

https://doi.org/10.20471/acc.2024.63.02.11

Computed tomography scoring scales as early outcome predictors in patients with traumatic brain injury: which one to use?

Jagoš Golubović orcid.org/0000-0001-5524-246X ; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Department of Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia *
Petar Vuleković ; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Department of Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia
Djula Djilvesi ; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Department of Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia
Nenad Krajčinović ; Department of Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia
Igor Horvat ; Department of Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia
Bojan Jelača ; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Department of Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia
Filip Pajičić ; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Department of Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia
Nebojša Lasica ; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Department of Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia
Srđan Stošić ; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Center of Radiology, University Clinical Center of Vojvodina, Novi Sad, Serbia
Ante Rotim ; Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Lukas Rasulić ; Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Division of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Department of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia

* Dopisni autor.

Sažetak

Computed tomography (CT) is an essential tool in diagnosing and treating traumatic
brain injury (TBI). Marshall CT classification, Rotterdam and Helsinki CT scores were consecutively
developed as prediction outcome scales by computing TBI CT abnormalities. None of them classifies the
pathological CT findings in the same manner. We aimed to determine which one is most accurate and has
the best grading discriminatory power in determining early outcome. All TBI patients treated at a single
center in a one-year period having undergone a CT scan on admission were retrospectively included. After
calculation of all three scores, comparison among scale performances, as well as their accuracy in predicting
patient 6-month outcome by the Glasgow Outcome Scale (GOS) was made. We used the Receiver Operating
Characteristic curves to analyze correlation between all scales and early outcome. We calculated the area
under the curve (AUC) to determine the power of each system while paired samples T-test was used to
determine correlation among the scales. Mann-Whitney U test was performed to determine difference in
outcome groups. A total of 1006 patients were included in final analysis. The mean patient age at presentation
was 55.6 (±20.1) years, overall mortality was 6.4%, mean GOS was 3.00 (±1.4), and mean Glasgow Coma
Score (GCS) was 13.9 (±0.2). Mortality was higher among patients with lower scores (p<0.01 all). The AUCs
indicated that all scoring systems had a similarly high discriminative power in predicting early unfavorable
outcome (Marshall AUC 0.86 vs. Rotterdam AUC 0.82 vs. Helsinki AUC 0.84). High correlation was found
between Marshall and Rotterdam grading, r = 0.78, and moderate correlation between the other two pairs
(Marshall vs. Helsinki, r=0.62, and Rotterdam vs. Helsinki, r=0.51). Additionally, low GCS and high injury
severity score (ISS) could be identified as strong predictors of early death and poor outcome. In conclusion,
all classification systems demonstrated a similar, strong predictive power for early outcome, but even greater
discrimination results could be obtained if GCS and ISS were incorporated in the calculation. Helsinki
CT score was least predictable of all three, and had the lowest correlation with the other two. Although
Marshall CT classification was the oldest and simplest, it had at least the same prediction power as the newer
scoring scales and should remain in use. Therefore, for prognostic purposes, this study recommends using one
individual scale in clinical application to get the best possible prediction for TBI.

Ključne riječi

Marshall CT classification; Rotterdam CT score; Helsinki CT score; Early death; Early outcome; Traumatic brain injury

Hrčak ID:

327958

URI

https://hrcak.srce.hr/327958

Datum izdavanja:

31.10.2025.

Podaci na drugim jezicima: hrvatski

Posjeta: 1.090 *