Sequential changes in Rotterdam CT scores related to outcomes for patients with traumatic brain injury who undergo decompressive craniectomy

Abstract

OBJECT Rotterdam CT scoring is a CT classification system for grouping patients with traumatic brain injury (TBI) based on multiple CT characteristics. This retrospective study aimed to determine the relationship between initial or preoperative Rotterdam CT scores and TBI prognosis after decompressive craniectomy (DC). METHODS The authors retrospectively reviewed the medical records of all consecutive patients who underwent DC for nonpenetrating TBI in 2 hospitals from January 2006 through December 2013. Univariate and multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were used to determine the relationship between initial or preoperative Rotterdam CT scores and mortality at 30 days or Glasgow Outcome Scale (GOS) scores at least 3 months after the time of injury. Unfavorable outcomes were GOS Scores 1-3 and favorable outcomes were GOS Scores 4 and 5. RESULTS A total of 48 cases involving patients who underwent DC for TBI were included in this study. Univariate analyses showed that initial Rotterdam CT scores were significantly associated with mortality and both initial and preoperative Rotterdam CT scores were significantly associated with unfavorable outcomes. Multivariable logistic regression analysis adjusted for established predictors of TBI outcomes showed that initial Rotterdam CT scores were significantly associated with mortality (OR 4.98, 95% CI 1.40-17.78, p = 0.01) and unfavorable outcomes (OR 3.66, 95% CI 1.29-10.39, p = 0.02) and preoperative Rotterdam CT scores were significantly associated with unfavorable outcomes (OR 15.29, 95% CI 2.50-93.53, p = 0.003). ROC curve analyses showed cutoff values for the initial Rotterdam CT score of 5.5 (area under the curve [AUC] 0.74, 95% CI 0.59-0.90, p = 0.009, sensitivity 50.0%, and specificity 88.2%) for mortality and 4.5 (AUC 0.71, 95% CI 0.56-0.86, p = 0.02, sensitivity 62.5%, and specificity 75.0%) for an unfavorable outcome and a cutoff value for the preoperative Rotterdam CT score of 4.5 (AUC 0.81, 95% CI 0.69-0.94, p < 0.001, sensitivity 90.6%, and specificity 56.2%) for an unfavorable outcome. CONCLUSIONS Assessment of changes in Rotterdam CT scores over time may serve as a prognostic indicator in TBI and can help determine which patients require DC.

Rotterdam Computed Tomography Score to Predict Outcome in Traumatic Brain Injury Patients

“…28 The authors concluded that the Rotterdam CT scoring system can be a relatively objective, simple, and practical tool to prognosticate the outcome in both adults and pediatric patients with TBI. 2,28,30,31 In our study, we found that easy-to-use model and result showed that the higher the Rotterdam CT score, the poorer the outcome (it is in agreement with published literature). 2,28,30,31…”

“…29 In the Rotterdam CT score, the authors included individual CT characteristics (i.e., the status of basal cisterns, midline shift, and types of mass lesions or intracranial hemorrhage) and combined them to develop a model to predict the outcome in patients with moderate to severe TBI who underwent decompressive craniectomy. 2,28,30,31 A study involving pediatric patients (<17 years) reports that children with lower scores have better survival outcome as compared with adults with same scoring, but children with higher Rotterdam CT scores have worst survival as compared with adults. 28 The authors concluded that the Rotterdam CT scoring system can be a relatively objective, simple, and practical tool to prognosticate the outcome in both adults and pediatric patients with TBI.…”

The role of serum Dickkopf‐1 in predicting 30‐day death in severe traumatic brain injury

“…We recorded the following trauma‐related radiological information: abnormal cisterns, midline shift, skull‐cap fracture, skull‐base fracture, epidural hematoma, subdural hematoma, subarachnoid hemorrhage, intraventricular hemorrhage, cerebral hematoma, brain contusion, and pneumocephalus. Radiological severity was classified in light of the Rotterdam CT classification (Fujimoto, Miura, Otsuka, & Kuratsu, 2016). In addition, progressive hemorrhagic injury, acute lung injury, and post‐traumatic cerebral infarction were defined based on the previous studies (Allard et al, 2009; Bernard et al, 1994; Mirvis, Wolf, Numaguchi, Corradino, & Joslyn, 1990).…”

Relevancia del puntaje de Rotterdam para el pronóstico de empeoramiento en pacientes con traumatismo encéfalocraneano

“…Varios estudios han demostrado la utilidad e inclusive la superioridad de esta escala, para la predicción de mortalidad y los malos resultados a corto y mediano plazo de los pacientes con TEC, después de la realización de craniectomía descompresiva e inclusive en pacientes pediátricos 5,6,15 . No obstante en la revisión sobre el tema llevada a cabo por los autores, no se encontró ninguna referencia que abordara la posible utilidad de la misma para realizar el pronóstico de la progresión de las lesiones intracraneales detectadas en la TC inicial, si bien Flint et al (citado por Fujimoto et al) 3 encontraron que la severidad del puntaje de Rotterdam en la TC inicial se asoció al riesgo de expansión de las contusiones encefálicas después de realizar craniectomía descompresiva.…”