Use of Rotterdam CT Scores for Mortality Risk Stratification in Children With Traumatic Brain Injury*

Abstract

Objective The Rotterdam computed tomography (CT) score refined features of the Marshall score and was designed to categorize traumatic brain injury (TBI) type and severity in adults. The objective of this study was to determine whether the Rotterdam CT score can be used for mortality risk stratification after pediatric TBI. Design In children with moderate to severe TBI, a comparison of observed versus predicted mortality calculated using published model probabilities of adult mortality. Development and validation of a new pediatric mortality model using randomly selected prediction and validation samples from our cohort. Setting A single level 1 pediatric trauma center. Subjects 632 children with moderate or severe TBI Interventions None. Measurements and Main Results Sixteen percent (101/632) of the patients died prior to hospital discharge. The predicted mortality based on Rotterdam score for adults with moderate or severe TBI discriminated pediatric observed mortality well (AUC = 0.85, 95% confidence interval [CI] 0.80 – 0.89) but had poor calibration, overestimating or underestimating mortality for children in several Rotterdam categories. A predictive model based on children with moderate or severe TBI from the single center discriminated mortality well (AUC 0.80, 95% CI 0.68 – 0.91) and showed good calibration and overall fit. Conclusions Children with TBI have better survival than adults in Rotterdam CT score categories representing less severe injuries, but worse survival than adults in higher score categories. A novel, validated pediatric mortality model based on the Rotterdam score is accurate in children with moderate or severe TBI and can be used for risk stratification.

ICP monitoring in children: why are we not adhering to guidelines?

“…Recent pediatric model taking into account GCS, Rotterdam score, mechanism of injury, and severity score proved to be accurate for prediction mortality risk stratification in pediatrics [12]. Our results support the link between GCS, reassuring tomography score and decision not to undergo ICP monitoring.…”

“…Final head CT reports were reviewed retrospectively for Rotterdam scoring [11]. Although conceived in adults, the score has recently been used for mortality risk stratification in children [12]. Initial GCS (median score (25th-75th percentile)) 6 (4-7) 6 (4-7) 6 (4-7)…”

“…Rotterdam CT imaging score of patients initially managed with clinical surveillance (N=14) Score, associated mortality 6 month post-injury[12] …”

Risk factors for traumatic blunt cerebrovascular injury diagnosed by computed tomography angiography in the pediatric population: a retrospective cohort study

“…Radiological variables recorded included the year of the CTA, institution where the CTA was performed, presence of a fracture in the petrous temporal bone, presence of a fracture through the carotid canal, fracture type (linear or comminuted), presence of injury to the internal carotid artery (ICA) or vertebral artery (VA), type of brain injury (that is, epidural, subdural, or subarachnoid hemorrhage), presence of hypodensity on images consistent with ischemia, Rotterdam score (a 6-point score, based on findings on initial noncontrast CT, that predicts the mortality rate at 6 months postinjury in moderate and severe TBI and has been validated in the pediatric population), 18,19 and radiation dose delivered to the patient measured in dose-length product. The primary outcome was ICA or VA injury identified by CTA, classified according to the BCVI scale: 3 a Grade 1 injury is characterized by intimal irregularity with < 25% narrowing, Grade 2 injury is a dissection or presence of intramural hematoma with > 25% narrowing, Grade 3 injury is the presence of a pseudoaneurysm, Grade 4 injury is an occlusion, and Grade 5 injury is transection with extravasation.…”

Predicting Blunt Cerebrovascular Injury in Pediatric Trauma: Validation of the “Utah Score”

“…Radiological variables included presence of petrous temporal bone fracture or fracture through the carotid canal as defined in the original paper. 14 We abstracted any concomitant intracranial injury (epidural, subdural, or subarachnoid hemorrhage), presence of hypodensity on CT imaging consistent with ischemia, Rotterdam score 15 (a 6-point score based on noncontrast CT findings that predicts 6-month mortality in moderate and severe TBI), 16 and CTA radiation dose. We recorded whether dedicated cervical spine imaging was performed, and if so, the modality, cervical spine injury type, level of injury, and fracture through the foramen transversarium.…”