Novel application of the Rotterdam CT score in the prediction of intracranial hypertension following severe traumatic brain injury

Abstract

OBJECTIVE Severe traumatic brain injury (TBI) is associated with intracranial hypertension (ICHTN). The Rotterdam CT score (RS) can predict clinical outcomes following TBI, but the relationship between the RS and ICHTN is unknown. The purpose of this study was to investigate clinical and radiological factors that predict ICHTN in patients with severe TBI. METHODS The authors performed a single-center retrospective review of patients who, between 2018 and 2021, had an intracranial pressure (ICP) monitor placed following TBI. Radiological and clinical characteristics related to the TBI and ICP monitoring were collected. The main outcome of interest was ICHTN, which was a dichotomous outcome (yes or no) defined on a per-patient basis as an ICP > 22 mm Hg that persisted for at least 5 minutes and required an escalation of treatment. ICHTN included both elevated opening pressure on initial monitor placement and ICP elevations later during hospitalization. Multivariate logistic regression was performed to determine variables associated with ICHTN. Diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve (AUROC). RESULTS Seventy patients with severe TBI and an ICP monitor were included in this study. There was a predominance of male patients (94.0%), and the mean patient age was 40 years old. Most patients (67%) had an intraparenchymal catheter placed, whereas 33% of patients had a ventriculostomy catheter placed. In the multivariate logistic regression analysis, the RS was an independent predictor of ICHTN (OR 2.0, 95% CI 1.2–3.5, p = 0.014). No instances of ICHTN were observed in patients with an RS of 2 or less and no sulcal effacement. The AUROC of the RS and sulcal effacement was higher than the AUROC of the RS alone for predicting ICHTN (0.76 vs 0.71, p = 0.003, z-test). CONCLUSIONS The RS was predictive of ICHTN in patients with severe TBI, and the diagnostic accuracy of the model was improved with the inclusion of sulcal effacement at the vertex on CT of the head. Patients with a low RS and no sulcal effacement are likely at low risk for the development of ICHTN.

Development and validation of a prognostic computed tomography scoring model for functional outcomes in patients with large hemispheric infarction following decompressive craniectomy

“…In 2005, the Rotterdam CT score, which is composed of the status of basal cisterns, midline shift, and types of mass lesions or intracranial hemorrhage, was developed for traumatic brain injury (TBI) ( 7 ). Recent studies have further confirmed the predictive value of the Rotterdam CT score for intracranial hypertension and its prognostic ability in patients undergoing DC following TBI ( 8 , 9 ). Thus, some characteristics (especially the status of cisterns and midline shift) in the Rotterdam CT score might be important replenishments for the prognosis prediction of LHIs in terms of their reflection of occupying effects and established predictive capability in potentially intracranial hypertension.…”

“…The first part was the evaluation of ASPECTS (focusing on the ischemia extent) ( 5 ). The second part was items yielded from the novel Rotterdam CT Score (focusing on the occupying effect) ( 9 ). The status of basal cisterns, midline shift, sulcal effacement, and types of mass lesions or intracranial hemorrhage were preceding reported items in the novel Rotterdam CT Score.…”

Incidence, risk factors, and clinical outcomes of acute brain swelling associated with traumatic acute subdural hematoma: a retrospective study utilizing novel diagnostic criteria

“…A recent study has demonstrated that sulcal effacement at the vertex is a reliable predictor of elevated ICP following TBI. 11 One of the purposes of this study was to ascertain the incidence of ABS associated with ASDH, encompassing hemispheric and whole-brain swelling. Therefore, we proposed novel CT-based criteria to clearly define this easily overlooked subtype of TBI.…”

“…The diagnosis of post-traumatic ABS was made on the basis of CT findings. In addition to examining the basal cisterns, an additional evaluation of sulcal effacement at the vertex 11 was also conducted using axial sequences of CT with a thickness of 5 mm. If necessary, both axial and coronal sequences of thinner CT were utilized to determine the status of the sulci and cisterns.…”

“…The criteria incorporate an evaluation of sulcal effacement at the vertex, which has been proven to be a reliable indicator for predicting elevated ICP after TBI. 11 The objectives of this study were threefold: (1) to determine the incidence of ABS associated with ASDH, including hemispheric and whole-brain swelling; (2) to identify potential risk factors for ABS associated with ASDH by analyzing clinical, laboratory, and radiological variables; and (3) to evaluate the clinical outcomes of ASDH associated with ABS.…”