The Prognostic Value of Rotterdam Computed Tomography Score in Predicting Early Outcomes Among Children with Traumatic Brain Injury

Talari, Hamid Reza; Hamidian, Yaser; Moussavi, Nooshin; Fakharian, Esmail; Abedzadeh-Kalahroudi, Masoumeh; Akbari, Hossein; Taher, Elaheh Baban

doi:10.1016/j.wneu.2018.12.221

Cited by 12 publications

(15 citation statements)

References 19 publications

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“…We found that patients with severe traumatic brain injury had higher rates of need for surgery. Previously, Talari et al [10] showed that the patients with the need for surgery had higher mortality compared to the patients without the need for surgery. The cure rate for both medical and surgical treatment decreases with the increasing Rotterdam score [10].…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Previously, Talari et al [10] showed that the patients with the need for surgery had higher mortality compared to the patients without the need for surgery. The cure rate for both medical and surgical treatment decreases with the increasing Rotterdam score [10]. Likewise, we found that the patients with a need for surgery had higher Rotterdam scores and severity of traumatic brain injury.…”

Section: Discussion/conclusionmentioning

confidence: 99%

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The Use of Rotterdam CT Score for Prediction of Outcomes in Pediatric Traumatic Brain Injury Patients Admitted to Emergency Service

et al. 2020

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Introduction: Rotterdam CT score for prediction of outcome in traumatic brain injury is widely used for patient evaluation. The data on the assessment of pediatric traumatic brain injury patients with the Rotterdam scale in our country are still limited. In this study, we aimed to evaluate the use of the Rotterdam scale on pediatric trauma patients in our country and assess its relationship with lesion type, location and severity, trauma type, and need for surgery. Methods: A total of 229 pediatric patients admitted to the emergency service due to head trauma were included in our study. Patients were evaluated in terms of age, gender, Glasgow Coma Scale (GCS), initial and follow-up Rotterdam scale scores, length of stay, presence of other traumas, seizures, antiepileptic drug use, need for surgical necessity, and final outcome. Results: A total of 229 patients were included in the study, and the mean age of the patients was 95.8 months. Of the patients, 87 (38%) were girls and 142 (62%) were boys. Regarding GCS at the time of admission, 59% (n = 135) of the patients had mild (GCS = 13–15), 30.6% (n = 70) had moderate (GCS = 9–12), and 10.5% (n = 24) had severe (GCS < 9) head trauma. The mean Rotterdam scale score was calculated as 1.51 (ranging from 1 to 3) for mild, 2.22 (ranging from 1 to 4) for moderate, and 4.33 (ranging from 2 to 6) for severe head trauma patients. Rotterdam scale score increases significantly as the degree of head injury increases (p < 0.001). Discussion: With the adequate use of GCS and cerebral computed tomography imaging, pediatric patients with a higher risk of mortality and need for surgery can be predicted. We recommend the follow-up of pediatric traumatic brain injury patients with repeated CT scans to observe alterations in Rotterdam CT scores, which may be predictive for the need for surgery and intensive care.

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Section: Discussion/conclusionmentioning

confidence: 99%

Section: Discussion/conclusionmentioning

confidence: 99%

The Use of Rotterdam CT Score for Prediction of Outcomes in Pediatric Traumatic Brain Injury Patients Admitted to Emergency Service

et al. 2020

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“…Additionally, other admission baseline characteristics, such as GCS score and pupillary reactivity, are traditionally considered unfavorable indicators. In terms of supplementary imaging indicators, we found that intracerebral hemorrhage (ICH), traumatic subarachnoid hematoma (tSAH) and basal cistern (obliteration or compressed) were incremental indicators that improved outcome prediction accuracy [32][33][34][35]. In addition, adding invasive laboratory indicators, such as blood glucose and circulating monocyte count, will substantially improve the accuracy [36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Chinese Admission Warning Strategy for Predicting the Hospital Discharge Outcome in Patients with Traumatic Brain Injury

Zheng

Zhuang

Zhao

et al. 2022

JCM

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Objective: To develop and validate an admission warning strategy that incorporates the general emergency department indicators for predicting the hospital discharge outcome of patients with traumatic brain injury (TBI) in China. Methods: This admission warning strategy was developed in a primary cohort that consisted of 605 patients with TBI who were admitted within 6 h of injury. The least absolute shrinkage and selection operator and multivariable logistic regression analysis were used to develop the early warning strategy of selected indicators. Two sub-cohorts consisting of 180 and 107 patients with TBI were used for the external validation. Results: Indicators of the strategy included three categories: baseline characteristics, imaging and laboratory indicators. This strategy displayed good calibration and good discrimination. A high C-index was reached in the internal validation. The multicenter external validation cohort still showed good discrimination C-indices. Decision curve analysis (DCA) showed the actual needs of this strategy when the possibility threshold was 0.01 for the primary cohort, and at thresholds of 0.02–0.83 and 0.01–0.88 for the two sub-cohorts, respectively. In addition, this strategy exhibited a significant prognostic capacity compared to the traditional single predictors, and this optimization was also observed in two external validation cohorts. Conclusions: We developed and validated an admission warning strategy that can be quickly deployed in the emergency department. This strategy can be used as an ideal tool for predicting hospital discharge outcomes and providing objective evidence for early informed consent of the hospital discharge outcome to the family members of TBI patients.

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“…Alterations in cerebral blood flow and metabolism may also be relevant. 15 Through the improvement of surgical methods, bbDC can always maintain the pressure balance on both sides of the cerebral hemisphere during and after surgery, minimize the possibility of delayed intracranial hematoma due to pressure tamponade effect, contralateral skull fracture, and rapid displacement of brain tissue. Furthermore, the secondary brain damage caused by the expansion of the brain tissue from the decompression window and the shift of the midline structure is prevented, then reduce the occurrence of serious complications and the surgical effect is improved.…”

Section: Discussionmentioning

confidence: 99%

“…Post-traumatic cerebral infarction is associated with increased ICP, insufficient CCP, and cerebral arteriosclerosis. 15 The blood vessels of Willis arterial circle are compressed on the tentorium margin after cerebral hernia, resulting in the occlusion of the major blood vessels at the cranial base, such as the anterior cerebral artery, middle cerebral artery, and posterior cerebral artery, causing a large area of cerebral infarction in the blood supply area, which is also an important cause of post-traumatic cerebral infarction. 11 Of the 10 patients in bbDC group, 2 patients had post-traumatic cerebral infarction, which was a watershed infarction, and there was no large-area cerebral infarction caused by occlusion of large vessels at the cranial base; while of the 13 patients in uDC group, 4 patients had post-traumatic cerebral infarction, including 1 case with anterior cerebral artery occlusion, 2 cases with middle cerebral artery occlusion, and 1 case with middle cerebral artery combined with posterior cerebral artery occlusion.…”

Section: Discussionmentioning

confidence: 99%

Clinical Value of Bilateral Balanced Frontotemporoparietal Decompressive Craniectomy in Severe Diffuse Traumatic Brain Injury

Wei

2021

Journal of Craniofacial Surgery

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Objective: To explore the clinical value of bilateral balanced frontotemporoparietal decompressive craniectomy (bbDC) in severe diffuse traumatic brain injury by comparison to the unilateral frontotemporoparietal decompressive craniectomy (uDC). Materials and Methods: Twenty three patients with severe diffuse traumatic brain injury from April 2015 to December 2019 were selected, including 10 cases underwent bbDC (bilateral group) and 13 cases underwent uDC (unilateral group). Compared with the postsurgical intracranial pressure (ICP), cerebral perfusion pressure, cerebral blood flow volume, postsurgical imaging score, the occurrence of complications as well as the 6 month outcome (Glasgow Outcome Scale, GOS) of two groups. Results: 1. The postsurgical ICP was lower in the bbDC group than in the uDC group, while the postsurgical CCP and cerebral blood flow volume were higher in the bbDC group than in the uDC group. 2. Postsurgical imaging scores of the bbDC group were lower, indicating that the decompression effect of bbDC was more exhaustive than that of the uDC group. 3. The incidence of intraoperative acute cerebral bulging was lower in bbDC group than in uDC group. 4. The bbDC could effectively reduce the proportion of patients with the worst prognosis (deadþvegetative state). Conclusion: For patients with severe, diffuse traumatic brain injury combined with bilateral or unilateral pupil dilation, bilateral balanced decompression craniotomy is an effective method, which should be performed as soon as possible. As compared to unilateral decompression, the decompression effect on the brainstem is more thorough; the incidence of acute cerebral bulging, postoperative incisional hernia, and postoperative cerebral infarction involving a large area are reduced. ICP can be better controlled, cerebral perfusion pressure and cerebral blood flow increases, improving the patient's survival rate, quality of life, and prognosis.

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The Prognostic Value of Rotterdam Computed Tomography Score in Predicting Early Outcomes Among Children with Traumatic Brain Injury

Cited by 12 publications

References 19 publications

The Use of Rotterdam CT Score for Prediction of Outcomes in Pediatric Traumatic Brain Injury Patients Admitted to Emergency Service

The Use of Rotterdam CT Score for Prediction of Outcomes in Pediatric Traumatic Brain Injury Patients Admitted to Emergency Service

Chinese Admission Warning Strategy for Predicting the Hospital Discharge Outcome in Patients with Traumatic Brain Injury

Clinical Value of Bilateral Balanced Frontotemporoparietal Decompressive Craniectomy in Severe Diffuse Traumatic Brain Injury

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