Rotterdam and Marshall Scores for Prediction of in-hospital Mortality in Patients with Traumatic Brain Injury: An observational study

Asim, Mohammad; El‐Menyar, Ayman; Parchani, Ashok; Nabir, Syed; Ahmed, Mohamed Nadeem; Ahmed, Zahoor; Ramzee, Ahmed Faidh; Al-Thani, Abdulaziz; Al‐Abdulmalek, Abdulrahman; Al-Thani, Hassan

doi:10.1080/02699052.2021.1927181

Cited by 17 publications

(14 citation statements)

References 25 publications

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“…The incidence of brain contusion (74.4%) was most prevalent among the survivors, while skull fractures (58.5%) were more prevalent among the non-survivors. A study by Asim et al observed that the major head injury lesion observed in survivors and non-survivors was a skull fracture [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…The Rotterdam score proposed revalued the components of Marshall's classification and added traumatic subarachnoid hemorrhage (tSAH), intraventricular hemorrhage (IVH), and epidural hematomas in order to create an ordinal score criterion [ 9 , 10 ]. The advantages of these prediction models, like reproducibility, minimum interobserver variability, and simplicity of use, make them a promising scoring system [ 11 ]. There is a paucity of data in the literature on Indian demographics regarding the utility of these scoring systems in predicting in-hospital mortality in patients with TBI.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of In-Hospital Mortality in Patients With Traumatic Brain Injury Using the Rotterdam and Marshall CT Scores: A Retrospective Study From Western India

Goswami¹,

Nanda²,

S³

et al. 2023

Cureus

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Objective Head trauma of any severity, including concussions and skull fractures, can cause a traumatic brain injury (TBI). Prognostication plays a vital role in the scenario of urgency put forth by TBI. The application of CT-based scoring systems developed by the Rotterdam CT score and Marshall classification system appears to be appropriate for the early and precise prediction of clinical outcomes in TBI patients. The present study was designed to determine the predictive value of the Rotterdam CT score and Marshall classification system for in-hospital mortality in patients with TBI. Methods All adult patients (≥ 18 years) with acute traumatic brain injury presented over a period from February 2019 to November 2022 were included. Only those patients who had undergone a plain CT scan of the brain during the initial presentation at the emergency department (ED) were considered. Patients who presented with penetrating brain injury as well as those who died on arrival or who died prior to the initial CT scan of the brain were excluded. A total of 127 patients were included in the final data analysis. Based on initial CT-scan findings, the Rotterdam CT score and Marshall classification system were calculated in order to predict in-hospital mortality. Results The study was dominated by male patients (85.8%) as compared to female patients (14.2%). The overall mortality rate was 32.3% (n = 41). The mortality rate among males and females was 30.3% (33/109) and 44.4% (8/18), respectively. As per the Glasgow Coma Scale (GCS) classification, the severity of the injury was mild in 12.6% of the study subjects, moderate in 22%, and severe in 65.4%. The mortality rate among the patients with mild severity was 12.5% (2/16), while it was 28.6% in moderate (8/28) and 37.3% (31/83) in the severe category group. The best cut-off point of the Rotterdam score for predicting mortality was >4 (as per the Youden Index), which had a sensitivity and specificity of 60.98% and 90.70%, respectively, while the cut-off point of the Marshall CT classification for predicting mortality was >3 (as per the Youden Index), which had a sensitivity of 82.93% and a specificity of 75.58%. There was only a minor difference in the area under the curve (AUC) value of the receiver operating characteristic curve (ROC) curve between the Rotterdam CT score (0.827) and the Marshall classification system (0.833). Conclusion The Rotterdam and Marshall CT scores have demonstrated significant independent prognostic value and may serve as a useful initial evaluation tool for risk stratification of in-hospital mortality among patients with TBI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prediction of In-Hospital Mortality in Patients With Traumatic Brain Injury Using the Rotterdam and Marshall CT Scores: A Retrospective Study From Western India

Goswami¹,

Nanda²,

S³

et al. 2023

Cureus

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“…The Marshall Score was defined according to the literature and our prior work. [ 19 ] Seizures were described as clinically observed fits, as continuous electroencephalogram (EEG) monitoring during this study was not feasible.…”

Section: Ethodsmentioning

confidence: 99%

Seizure Prophylaxis in Young Patients Following Traumatic Brain Injury

Bahey,

Chughtai,

El-Menyar

et al. 2024

Journal of Emergencies, Trauma, and Shock

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Introduction: Phenytoin is one of the commonly used anti-seizure medications in nontraumatic seizures. However, its utility and safety in young patients with traumatic brain injury (TBI) for the prevention of early-onset seizures (EOS) are debatable. We sought to explore the use of phenytoin as a seizure prophylaxis following TBI. We hypothesized that administering phenytoin is not effective in preventing EOS after TBI. Methods: This was a retrospective observational study conducted on adult TBI patients. EOS was defined as a witnessed seizure within a week postinjury. Data were compared as phenytoin versus no-phenytoin use, EOS versus no-EOS, and among TBI severity groups. Results: During 1 year, 639 TBI patients were included with a mean age of 32 years; of them, 183 received phenytoin as seizure prophylaxis, and 453 received no prophylaxis medication. EOS was documented in 13 (2.0%) patients who received phenytoin, and none had EOS among the nonphenytoin group. The phenytoin group was more likely to have a higher Marshall Score (P = 0.001), lower Glasgow Coma Scale (GCS) (P = 0.001), EOS (P = 0.001), and higher mortality (P = 0.001). Phenytoin was administrated for 15.2%, 43.2%, and 64.5% of mild, moderate, and severe TBI patients, respectively. EOS and no-EOS groups were comparable for age, gender, mechanism of injury, GCS, Marshall Score, serum phenytoin levels, liver function levels, hospital stay, and mortality. Multivariable logistic regression analysis showed that low serum albumin (odds ratio [OR] 0.81; 95% confidence interval [CI] 0.676–0.962) and toxic phenytoin level (OR 43; 95% CI 2.420–780.7) were independent predictors of EOS. Conclusions: In this study, the prophylactic use of phenytoin in TBI was ineffective in preventing EOS. Large-scale matched studies and well-defined hospital protocols are needed for the proper utility of phenytoin post-TBI.

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“…Four CT-based metrics-the Marshall, Rotterdam, Stockholm, and Helsinki scores-have been developed to predict patient mortality 6 months from the time of injury. [121][122][123] The Marshall classification system is the oldest and has been used extensively to inform prognostication after TBI. The Marshall score classifies the presence or absence of lesions with mass effect, compression of the basal cisterns, and deviations of structures from the midline.…”

Section: Multi-injury Ct Scoring Systemsmentioning

confidence: 99%

Prognostic Neuroimaging Biomarkers in Acute Vascular Brain Injury and Traumatic Brain Injury

Krawchuk,

Sharrock

2023

Semin Neurol

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Prognostic imaging biomarkers after acute brain injury inform treatment decisions, track the progression of intracranial injury, and can be used in shared decision-making processes with families. Herein, key established biomarkers and prognostic scoring systems are surveyed in the literature, and their applications in clinical practice and clinical trials are discussed. Biomarkers in acute ischemic stroke include computed tomography (CT) hypodensity scoring, diffusion-weighted lesion volume, and core infarct size on perfusion imaging. Intracerebral hemorrhage biomarkers include hemorrhage volume, expansion, and location. Aneurysmal subarachnoid biomarkers include hemorrhage grading, presence of diffusion-restricting lesions, and acute hydrocephalus. Traumatic brain injury CT scoring systems, contusion expansion, and diffuse axonal injury grading are reviewed. Emerging biomarkers including white matter disease scoring, diffusion tensor imaging, and the automated calculation of scoring systems and volumetrics are discussed.

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Rotterdam and Marshall Scores for Prediction of in-hospital Mortality in Patients with Traumatic Brain Injury: An observational study

Cited by 17 publications

References 25 publications

Prediction of In-Hospital Mortality in Patients With Traumatic Brain Injury Using the Rotterdam and Marshall CT Scores: A Retrospective Study From Western India

Prediction of In-Hospital Mortality in Patients With Traumatic Brain Injury Using the Rotterdam and Marshall CT Scores: A Retrospective Study From Western India

Seizure Prophylaxis in Young Patients Following Traumatic Brain Injury

Prognostic Neuroimaging Biomarkers in Acute Vascular Brain Injury and Traumatic Brain Injury

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