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

Katar, Salim; Öztürk, Pınar Aydın; Özel, Mehmet; Araç, Songül; Evran, Şevket; Çevik, Serdar; Baran, Oğuz

doi:10.1159/000510016

Cited by 7 publications

(4 citation statements)

References 15 publications

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“…ROC AUC to delineate the strength in predicting survival in pediatric patients was 0.838 and 0.781 and for GOS ≤ 3 was 0.748 and 0.663 for Rotterdam and Marshall CT score 42. Similar results were found for the Rotterdam score in other studies 43.…”

supporting

confidence: 81%

Predictive Value of Rotterdam Score and Marshall Score in Traumatic Brain Injury: A Contemporary Review

Mishra

Ucros

Florez-Perdomo

et al. 2021

Indian Journal of Neurotrauma

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This article conducts a contemporary comparative review of the medical literature to update and establish evidence as to which framework among Rotterdam and Marshall computed tomography (CT)-based scoring systems predicts traumatic brain injury (TBI) outcomes better. The scheme followed was following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for literature search. The search started on August 15, 2020 and ended on December 31, 2020. The combination terms used were Medical Subject Headings terms, combination keywords, and specific words used for describing various pathologies of TBI to identify the most relevant article in each database. PICO question to guide the search strategy was: “what is the use of Marshall (I) versus Rotterdam score (C) in TBI patients (P) for mortality risk stratification (O).” The review is based on 46 references which included a full review of 14 articles for adult TBI patients and 6 articles for pediatric TBI articles comparing Rotterdam and Marshall CT scores. The review includes 8,243 patients, of which 2,365 were pediatric and 5,878 were adult TBI patients. Marshall CT classification is not ordinal, is more descriptive, has better inter-rater reliability, and poor performance in a specific group of TBI patients requiring decompressive craniectomy. Rotterdam CT classification is ordinal, has better discriminatory power, and a better description of the dynamics of intracranial changes. The two scoring systems are complimentary. A combination of clinical parameters, severity, ischemic and hemodynamic parameters, and CT scoring system could predict the prognosis of TBI patients with significant accuracy. None of the classifications has good evidence for use in pediatric patients.

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supporting

confidence: 81%

Predictive Value of Rotterdam Score and Marshall Score in Traumatic Brain Injury: A Contemporary Review

Mishra

Ucros

Florez-Perdomo

et al. 2021

Indian Journal of Neurotrauma

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“…Increased Rotterdam CT scores have been associated with increased mortality in adult patients with mild-to-severe TBI. [35][36][37] Ours is the first model to suggest a relationship between Rotterdam CT scores and development of circulatory shock. Our model suggests that higher GCS on admission to the ED may decrease odds of developing circulatory shock.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Neurological Outcomes Associated With Circulatory Shock After Moderate–Severe Traumatic Brain Injury: A TRACK-TBI Study

et al. 2022

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BACKGROUND: Extracranial multisystem organ failure is a common sequela of severe traumatic brain injury (TBI). Risk factors for developing circulatory shock and long-term functional outcomes of this patient subset are poorly understood. OBJECTIVE: To identify emergency department predictors of circulatory shock after moderate-severe TBI and examine long-term functional outcomes in patients with moderate-severe TBI who developed circulatory shock. METHODS: We conducted a retrospective cohort study using the Transforming Clinical Research and Knowledge in TBI database for adult patients with moderate-severe TBI, defined as a Glasgow Coma Scale (GCS) score of <13 and stratified by the development of circulatory shock within 72 hours of hospital admission (Sequential Organ Failure Assessment score ≥2). Demographic and clinical data were assessed with descriptive statistics. A forward selection regression model examined risk factors for the development of circulatory shock. Functional outcomes were examined using multivariable regression models. RESULTS: Of our moderate-severe TBI population (n = 407), 168 (41.2%) developed circulatory shock. Our predictive model suggested that race, computed tomography Rotterdam scores <3, GCS in the emergency department, and development of hypotension in the emergency department were associated with developing circulatory shock. Those who developed shock had less favorable 6-month functional outcomes measured by the 6-month GCS-Extended (odds ratio 0.36, P = .002) and 6-month Disability Rating Scale score (Diff. in means 3.86, P = .002) and a longer length of hospital stay (Diff. in means 11.0 days, P < .001). CONCLUSION: We report potential risk factors for circulatory shock after moderatesevere TBI. Our study suggests that developing circulatory shock after moderate-severe TBI is associated with poor long-term functional outcomes.

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“…54 There are five predictor variables to identify children requiring ICU-level care: GCS <15, non-isolated head injury, and on CT a midline shift >5 mm, absent cisterns, or intraventricular hemorrhage. 47 55 Implementing these predictors leads to ICU-admission rates of 66 to 81% in this group. Retrospectively only 14% really need ICU-level care, defined as transfusion, intubation, cardiopulmonary instability, invasive monitoring, or (neuro)surgical procedures.…”

Section: Epidemiologymentioning

confidence: 99%

A Child Presenting with a Glasgow Coma Scale Score of 13: Mild or Moderate Traumatic Brain Injury? A Narrative Review

Hageman

Nihom

2021

Neuropediatrics

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Objective The objective of this article was to compare children with traumatic brain injury (TBI) and Glasgow Coma Scale score (GCS) 13 with children presenting with GCS 14 and 15 and GCS 9 to 12. Data Source We searched PubMed for clinical studies of children of 0 to 18 years of age with mild TBI (mTBI) and moderate TBI, published in English language in the period of 2000 to 2020. Study Selection We selected studies sub-classifying children with GCS 13 in comparison with GCS 14 and 15 and 9 to 12. We excluded reviews, meta-analyses, non-U.S./European population studies, studies of abusive head trauma, and severe TBI. Data Synthesis Most children (>85%) with an mTBI present at the emergency department with an initial GCS 15. A minority of only 5% present with GCS 13, 40% of which sustain a high-energy trauma. Compared with GCS 15, they present with a longer duration of unconsciousness and of post-traumatic amnesia. More often head computerized tomography scans show abnormalities (in 9–16%), leading to neurosurgical intervention in 3 to 8%. Also, higher rates of severe extracranial injury are reported. Admission is indicated in more than 90%, with a median length of hospitalization of more than 4 days and 28% requiring intensive care unit level care. These data are more consistent with children with GCS 9 to 12. In children with GCS 15, all these numbers are much lower. Conclusion We advocate classifying children with GCS 13 as moderate TBI and treat them accordingly.

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

Cited by 7 publications

References 15 publications

Predictive Value of Rotterdam Score and Marshall Score in Traumatic Brain Injury: A Contemporary Review

Predictive Value of Rotterdam Score and Marshall Score in Traumatic Brain Injury: A Contemporary Review

Risk Factors and Neurological Outcomes Associated With Circulatory Shock After Moderate–Severe Traumatic Brain Injury: A TRACK-TBI Study

A Child Presenting with a Glasgow Coma Scale Score of 13: Mild or Moderate Traumatic Brain Injury? A Narrative Review

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