TO ASSESS THE ACCURACY OF PREDICTIVE MORTALITY OF ROTTERDAM VERSUS MARSHALL CT SCORE FOLLOWING SEVERE TRAUMATIC BRAIN INJURY
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Keywords
Traumatic brain injury, prognosis, emergency, mortality
Abstract
Background: Rapid and appropriate identification and prognostic prediction of traumatic brain injury (TBI) in the emergency department (ED) are essential for decreasing the risk of mortality. Computed tomography (CT) diagnostic methods developed by Rotterdam and Marshall have been shown to be quite helpful in predicting the likely outcome of TBI patients.
Objective: To compare the diagnostic accuracy of the Rotterdam CT score with the Marshall CT score in predicting death after severe TBI.
Methods: A longitudinal research on adult severe TBI patients was conducted in the ED of Ziauddin University Hospital, Karachi. Ninety severe TBI patients, aged over 18 years, were consecutively enrolled from 23-08-2023. To 22-02-2024 Vitals were recorded after demographic and trauma information was obtained. To confirm severe TBI, each patient's GCS score was calculated, and a CT scan was performed at admission. The Marshall and Rotterdam CT scores were calculated to predict their likelihood of death. The Statistical Package for the Social Sciences (SPSS) was used to analyze the data.
Results: Of the 90, 68.9% (n=62) were male patients, and 31.1% (n=28) were female patients, with a median age of 34.0 years. The predicted mortality from severe TBI with Rotterdam and Marshall CT scores ≥4 was 31.1% (n=28) and 44.4% (n=44), respectively. The actual mortality from severe TBI within 30 days of diagnosis was 41.1% (n=37). The Rotterdam and Marshall CT scores ≥4 predicted the mortality with a sensitivity of 62.2% and 83.8%, specificity of 90.6% and 83.1%, PPV of 82.2% and 77.5%, NPV of 77.5% and 88.0%, and DA of 78.9% and 83.4%, respectively.
Conclusion: Severe TBI patients have a higher chance of mortality if they score ≥4 on the Rotterdam and Marshall CT scores. These scoring methods are supported by the results of our study, which showed that a cutoff score of ≥4 was associated with poor survival and <4 with better survival.
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Dr Barkat Ullah
Registrar Emergency Medicine, Dr. Ziauddin Hospital North Karachi Pakistan
Dr Inayat Ali Khan
Neurosurgeon, Assistant Professor, HOD Emergency Medicine, Dr. Ziauddin Medical University Hospital Karachi Pakistan.
Dr Asif Nawaz
Registrar Emergency Medicine, Maroof International Hospital Islamabad Pakistan
Dr Muhammad Asad Khan
Registrar Emergency Medicine, Dr. Ziauddin Medical University Hospital Karachi Pakistan.
Dr Sana Ilyas
Postgraduate MD Emergency Medicine, Dr. Ziauddin Hospital North Nazimabad Karachi Karachi Pakistan.
Dr Hani Suhail
Postgraduate MD Emergency Medicine, Dr. Ziauddin Hospital North Nazimabad Karachi Pakistan.