Mohammadifard Mahyar, Ghaemi Kazem, Hanif Hamed, Sharifzadeh Gholamreza, Haghparast Marzieh
Department of Radiology, Imam Reza Hospital, Birjand University of Medical Sciences, Birjand.
Department of Neurosurgery, Birjand University of Medical Science, Birjand.
Eur J Transl Myol. 2018 Jul 16;28(3):7542. doi: 10.4081/ejtm.2018.7542. eCollection 2018 Jul 10.
Trauma is one of the most important issues of most healthcare systems accompanying with head trauma in the most cases. We sought to determine the scoring system and initial Computed Tomography (CT) findings predicting the death at hospital discharge (early death) in patients with traumatic brain injury based on Marshall and Rotterdam CT scores. This is a cross sectional study on traumatic neurosurgical patients with mild-to-severe traumatic brain injury admitted to the emergency department of Emam Reza Hospital, Birjand University of Medical Sciences. Patients≥18 years old with TBI during last 24 hours with GCS≤13 were included and exclusion criteria were multiple trauma, penetrating injuries, previous history of anticoagulant therapy, pregnancy, not willingness for participation. Their initial CT and status at hospital discharge, one and three months (dead or alive) were reviewed, and both CT scores were calculated. We examined whether each score is related to death using SPSS11 by The Mann-Whitney U at the level of p≤0.05. Overall, 98 patients were included. Mean age was 43.52±21.29. Most patients were male (63.3%). Mean Marshall and Rotterdam CT scores were 3.2±1.3 and 2.5±1. The mortality at two weeks, one moth and three months were 19.4%, 20.4%, and 20.4%. Rotterdam CT score was significantly different based on type of hematoma. Median GCS score in alive and dead patients on 2 weeks were 10 and 4 (p=0.0001), at one month were 10 and 4 (p=0.0001), and at three months were 10 and 4 (p=0.0001). The median Marshall CT score on 2 weeks were 2 and 4 (p=0.0001), at one month were 2 and 4 (p=0.0001), and at three months were 2 and 4 (p=0.0001). The median Rotterdam CT score on 2 weeks were 2 and 4 (p=0.0001), at one month were 2 and 3 (p=0.001), and at three months were 2 and 3 (p=0.001). The Rotterdam CT score was significantly correlated with mortality at two weeks, one month and three months (p=0.004, p=0.001, and p=0.001, respectively). The Marshall CT score was not significantly correlated with mortality at any time. The Rotterdam CT score was more accurate for prediction of mortality on 2 weeks (ROC80.9), at one month (ROC80.7), and at three months were (ROC80.7) than The Rotterdam CT score (ROC 76, 74.1, and 74.1, respectively). This study concluded that The Marshall CT score was more accurate for prediction of mortality on 2 weeks, at one month, and at three months were than The Marshall CT score with higher ROC. The correlation of the Rotterdam CT score with mortality was significant.
创伤是大多数医疗系统中最重要的问题之一，在大多数情况下都伴有头部创伤。我们试图基于马歇尔（Marshall）和鹿特丹（Rotterdam）CT评分来确定预测创伤性脑损伤患者出院时死亡（早期死亡）的评分系统和初始计算机断层扫描（CT）结果。这是一项针对比尔詹德医科大学伊玛目礼萨医院急诊科收治的轻至重度创伤性脑损伤的创伤神经外科患者的横断面研究。纳入年龄≥18岁、在过去24小时内发生创伤性脑损伤且格拉斯哥昏迷量表（GCS）评分≤13的患者，排除标准为多发伤、穿透伤、既往抗凝治疗史、妊娠、不愿意参与。回顾了他们的初始CT及出院时、1个月和3个月时的状态（死亡或存活），并计算了两种CT评分。我们使用SPSS11软件，通过曼-惠特尼U检验在p≤0.05水平上检验每种评分是否与死亡相关。总体而言，纳入了98例患者。平均年龄为43.52±21.29岁。大多数患者为男性（63.3%）。马歇尔CT评分和鹿特丹CT评分的平均值分别为3.2±1.3和2.5±1。两周、1个月和3个月时的死亡率分别为19.4%、20.4%和20.4%。基于血肿类型，鹿特丹CT评分有显著差异。存活和死亡患者在2周时的GCS评分中位数分别为10和4（p = 0.0001），1个月时分别为10和4（p = 0.0001），3个月时分别为10和4（p = 0.0001）。马歇尔CT评分在2周时的中位数分别为2和4（p = 0.0001），1个月时分别为2和4（p = 0.0001），3个月时分别为2和4（p = 0.0001）。鹿特丹CT评分在2周时的中位数分别为2和4（p = 0.0001），1个月时分别为2和3（p = 0.001），3个月时分别为2和3（p = 0.001）。鹿特丹CT评分与两周、1个月和3个月时的死亡率显著相关（分别为p = 0.004、p = 0.001和p = 0.001）。马歇尔CT评分在任何时间与死亡率均无显著相关性。与马歇尔CT评分相比，鹿特丹CT评分在预测2周（ROC 80.9）、1个月（ROC 80.7）和3个月（ROC 80.7）时的死亡率方面更准确（马歇尔CT评分的ROC分别为76、74.1和74.1）。本研究得出结论，马歇尔CT评分在预测2周、1个月和3个月时的死亡率方面比马歇尔CT评分更准确，其ROC更高。鹿特丹CT评分与死亡率的相关性显著。
