====== Rotterdam CT score ======

[[Traumatic brain injury CT Classification]].

The [[Rotterdam CT score]] refined features of the [[Marshall computed tomography classification]] and was designed to categorize [[traumatic brain injury]] type and severity in adults. The score was developed for prognostic purposes.

see [[Helsinki CT score]]

====Scoring items====

===Basal cisterns===

0: normal

1: compressed

2: absent

===Midline shift===

0: no shift or <= 5mm

1: shift > 5mm

===Epidural mass lesion===

0: present

1: absent

===Intraventricular blood or traumatic SAH===

0: absent

1: present

====Instructions for use====

The final score is the sum of the scoring items + 1.

====Mortality at 6 months post-injury====

Score 1: 0%

Score 2: 7%

Score 3: 16%

Score 4: 26%

Score 5: 53%

Score 6: 61% ((Maas AIR, Hukkelhoven CWPM, Marshall LF, Steyerberg EW. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery. 2005 Dec.;57(6):1173-82)).
----
Charry et al. analyzed 127 patients with severe TBI treated in the [[Neiva University Hospital]], over a 2-year period. [[Bivariate analysis]] and [[multivariate analysis]] were used. The [[discriminatory power]] of the [[score]], its accuracy, and precision were assessed by [[logistic regression]] and as the [[area under the receiver operating characteristic]] curve. [[Shapiro-Wilk test]], [[Chi-square]], and [[Wilcoxon signed rank test]] were used to compare the real [[outcome]]s in the [[cohort]] against the predicted outcomes.

The median age of the patient cohort was 33 years, and 84.25% were male. The median [[injury severity score]] was 25, the median [[Glasgow Coma Scale]] motor score was 3, the [[basal cistern]]s were closed in 46.46% of the patients, and a [[midline shift]] of >5 mm was seen in 50.39%. The 6-month [[mortality]] was 29.13%, and the Rotterdam CT score predicted a mortality of 26% (P < 0.0001) (area under the curve: 0.825; 95% [[confidence interval]]: 0.745-0.903).

The Rotterdam CT score predicted [[mortality]] at 6 months in patients with severe head trauma in a university hospital in [[Colombia]]. The Rotterdam CT score is useful for predicting early death and the prognosis of patients with TBI
((Charry JD, Falla JD, Ochoa JD, Pinzón MA, Tejada JH, Henriquez MJ, Solano JP, 
Calvache C. External Validation of the Rotterdam Computed Tomography Score in the
Prediction of Mortality in Severe Traumatic Brain Injury. J Neurosci Rural Pract.
2017 Aug;8(Suppl 1):S23-S26. doi: 10.4103/jnrp.jnrp_434_16. PubMed PMID:
28936067; PubMed Central PMCID: PMC5602255.
)).
----
The Rotterdam CT score provides great prognostic discrimination and is an independent predictor of unfavorable outcomes. Huang et al. suggest that the Rotterdam CT score be included as a prognosticator in the overall assessment of clinical condition of TBI patients before decompressive craniectomy (DC)
((Huang YH, Deng YH, Lee TC, Chen WF. Rotterdam computed tomography score as a
prognosticator in head-injured patients undergoing decompressive craniectomy.
Neurosurgery. 2012 Jul;71(1):80-5. doi: 10.1227/NEU.0b013e3182517aa1. PubMed
PMID: 22382208.
)).


Children with traumatic brain injury 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 traumatic brain injury and can be used for risk stratification
((Liesemer K, Riva-Cambrin J, Bennett KS, Bratton SL, Tran H, Metzger RR,
Bennett TD. Use of Rotterdam CT scores for mortality risk stratification in
children with traumatic brain injury. Pediatr Crit Care Med. 2014
Jul;15(6):554-62. doi: 10.1097/PCC.0000000000000150. PubMed PMID: 24751786;
PubMed Central PMCID: PMC4087067.)).

Since its introduction in 2005, few studies have compared the performance of the [[Marshall computed tomography classification]] and the Rotterdam CT score for predicting long-term outcome (neurological and mortality) of patients with TBI
((Raj R, Siironen J, Skrifvars MB, Hernesniemi J, Kivisaari R. Predicting
outcome in traumatic brain injury: development of a novel computerized tomography
classification system (Helsinki computerized tomography score). Neurosurgery.
2014 Dec;75(6):632-46; discussion 646-7. doi: 10.1227/NEU.0000000000000533.
PubMed PMID: 25181434.
)).