Predicting Outcome in Traumatic Brain Injury

BACKGROUND: Early computerized tomography (CT) abnormalities are important predictors of outcome after traumatic brain injury (TBI). OBJECTIVE: To develop a novel CT scoring system (Helsinki CT score) and to compare it with the Marshall CT classification and the Rotterdam CT score in predicting long-term outcome of patients with TBI. METHODS: Eight hundred sixty-nine consecutive TBI patients were included in this open-cohort, retrospective, single-center study. Logistic regression was used to develop the Helsinki CT score. The scores from the Marshall, Rotterdam, and Helsinki CT scoring methods were added to a clinical model based on age, motor score, and pupils to evaluate their value in predicting outcome. Internal validity was assessed by a bootstrap technique and expressed as area under the curve (AUC). Outcome was 6-month unfavorable neurological outcome and mortality. RESULTS: Variables included in the Helsinki CT score were bleeding type and size, intraventricular hemorrhage, and suprasellar cisterns. In the present data set, the performance of the Helsinki CT score was superior to that of the Marshall CT and Rotterdam CT scores (AUC, 0.74-0.75 vs 0.63-0.70; P < .001). Addition of the Helsinki CT score modestly increased prognostic performance of the clinical model (AUC neurological outcome +0.02 [P = .002]; AUC mortality, +0.01 [P = .21]). In contrast, the Marshall and Rotterdam CT scores were of no additional predictive value to the clinical model (P > .05). CONCLUSION: Use of the novel Helsinki CT score improved outcome prediction accuracy, and the Helsinki CT score is a feasible alternative to the Rotterdam and Marshall CT systems. External validation of the Helsinki CT score is advocated to show generalizability. ABBREVIATIONS: AOR, adjusted odds ratio AUC, area under the receiver-operating curve CI, confidence interval EDH, epidural hematoma GCS, Glasgow Coma Scale GOS, Glasgow Outcome Scale ICH, intracerebral hemorrhage IMPACT, International Mission for Prognosis and Analysis of Clinical Trials in TBI IVH, intraventricular hemorrhage SDH, subdural hematoma TBO, traumatic brain injury tSAH, traumatic subarachnoid hemorrhage