Comparison of the Ability of Marshall and Rotterdam CT scan Scoring System in Determining the Prognosis of Traumatic Brain Injury Patients: A Cross-Sectional Study

Predicting the final outcome of patients with traumatic brain injury is crucial for making the right clinical decision and determining the course of treatment. The aim of this study was to compare the ability of Marshall and Rotterdam scoring systems to determine the prognosis in patients with traumatic brain injury.

The present study is cross-sectional. The statistical population of the study consisted of patients with traumatic brain injury admitted to the intensive care unit of Khatam al-Anbia Hospital in Zahedan from 2021 to 2022. 287 patients were selected by convenience sampling method based on inclusion criteria. Patients were first evaluated by an intensive care physician to determine the prognosis with the APACH II Scale. The Marshall and Rotterdam scores of each patient were then determined by a radiologist based on a brain CT scan, and the patients were evaluated for the entire period of hospitalization until the final outcome (discharge or death) was determined. Finally, the data were compared to determine the ability of the two scales to predict outcomes.

Out of 287 patients, 33(11.5%) died and 254 (88.5%) survived. The mean score of the Marshall Scale in deceased patients was 4.69±1.01 and in survived patients was 2.03±1.3. The mean score of the Rotterdam Scale in deceased patients was 5.33±0.95 and in survived patients was 2.14±0.89. In both cases, this difference was statistically significant (P=0.001). The mean score of APACH II scale was 24.04±8.2 in deceased patients and 16.08±7.3 in survived patients. The correlation between Rotterdam and Marshall Scales in determining the outcome of patients, with APACH II was positive and high. The agreement between the APACH II and Rotterdam scales was greater in predicting mortality. The results of regression model showed that gender with (OR=2.91), head injury due to accident with (OR=3.04), Marshall Score above 4 (OR=1.97), Rotterdam score above 4 (OR=2.84) and Apache II score above 15 (OR=1.97) have a significant relationship with patient mortality.

Both the Marshall and Rotterdam scales can determine the prognosis of patients with traumatic brain injury.