Selection of CT variables and prognostic models for outcome prediction in patients with traumatic brain injury

Abstract

Background Traumatic brain injuries (TBI) are associated with high risk of morbidity and mortality. Early outcome prediction in patients with TBI require reliable data input and stable prognostic models. The aim of this investigation was to analyze different CT classification systems and prognostic calculators in a representative population of TBI-patients, with known outcomes, in a neurointensive care unit (NICU), to identify the most suitable CT scoring system for continued research. Materials and methods We retrospectively included 158 consecutive patients with TBI admitted to the NICU at a level 1 trauma center in Sweden from 2012 to 2016. Baseline data on admission was recorded, CT scans were reviewed, and patient outcome one year after trauma was assessed according to Glasgow Outcome Scale (GOS). The Marshall classification, Rotterdam scoring system, Helsinki CT score and Stockholm CT score were tested, in addition to the IMPACT and CRASH prognostic calculators. The results were then compared with the actual outcomes. Results Glasgow Coma Scale score on admission was 3–8 in 38%, 9–13 in 27.2%, and 14–15 in 34.8% of the patients. GOS after one year showed good recovery in 15.8%, moderate disability in 27.2%, severe disability in 24.7%, vegetative state in 1.3% and death in 29.7%. When adding the variables from the IMPACT base model to the CT scoring systems, the Stockholm CT score yielded the strongest relationship to actual outcome. The results from the prognostic calculators IMPACT and CRASH were divided into two subgroups of mortality (percentages); ≤50% (favorable outcome) and > 50% (unfavorable outcome). This yielded favorable IMPACT and CRASH scores in 54.4 and 38.0% respectively. Conclusion The Stockholm CT score and the Helsinki score yielded the closest relationship between the models and the actual outcomes in this consecutive patient series, representative of a NICU TBI-population. Furthermore, the Stockholm CT score yielded the strongest overall relationship when adding variables from the IMPACT base model and would be our method of choice for continued research when using any of the current available CT score models.

Impact of Intracranial Hypertension on Outcome of Severe Traumatic Brain Injury Pediatric Patients: A 15-Year Single Center Experience

“…Moreover, certain CT findings were found closely predictive of IC-HTN. Similarly to our results, recent studies report the better performance of the more detailed Helsinki CT score in predicting unfavorable outcomes [ 52 , 56 , 57 , 58 , 59 ]. Based on our records, anisocoria and higher Rotterdam CT scores yielded the best predictive model regarding the risk for last-tier interventions, while a validated pediatric mortality model based on Rotterdam CT score has recently been reported as accurate in children with moderate to severe TBI, and higher Rotterdam scores have been associated with worse survival in children compared to adults [ 60 ].…”

Hyperbaric oxygen therapy promotes consciousness, cognitive function, and prognosis recovery in patients following traumatic brain injury through various pathways

“…The Stockholm CT score is usually used to grade severity and predict the prognosis of TBI ( 30 ), thus rapidly and accurately reflecting the state of injury and enabling dynamic monitoring of the development and prognosis of structural lesions. This study used the Stockholm CT score to compare intracranial injuries before and after treatment; HBO decreased the intracranial hematoma volume after TBI, probably through increasing oxygen concentrations and promoting circulation.…”

External validation of the NeuroImaging Radiological Interpretation System and Helsinki computed tomography score for mortality prediction in patients with traumatic brain injury treated in the intensive care unit: a Finnish intensive care consortium study

“…In contrast to the NIRIS, the Helsinki CT score was developed for outcome prediction in patients with TBI treated in the ICU [ 17 ]. The Helsinki CT score has been validated in pediatric TBI patients (AUC 0.84) [ 9 ], penetrating TBI patients (AUC 0.90) [ 6 ], and adult TBI patients (AUC 0.70–0.81) [ 1 , 5 , 20 , 23 , 26 ] with good performance. We found similar performance measures in the present cohort (AUC 0.73, Nagelkerke’s R 2 0.20).…”