====== Stockholm CT score ======

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New [[Traumatic brain injury CT Classification]]s have emerged, including the [[Stockholm CT score]] in 2010
((Nelson DW, Nyström H, MacCallum RM, Thornquist B, Lilja A, Bellander BM,
Rudehill A, Wanecek M, Weitzberg E. Extended analysis of early computed
tomography scans of traumatic brain injured patients and relations to outcome. J 
Neurotrauma. 2010 Jan;27(1):51-64. doi: 10.1089/neu.2009.0986. PubMed PMID:
19698072.
)) 
and the [[Helsinki CT score]] in 2014 
((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.
)).

The Stockholm CT score uses [[midline shift]] as a continuous variable (as compared to the Marshall computed tomography classification’s and Rotterdam CT score’s threshold of ≥5 mm) and has a separate scoring for tSAH
((Nelson DW, Nyström H, MacCallum RM, Thornquist B, Lilja A, Bellander BM,
Rudehill A, Wanecek M, Weitzberg E. Extended analysis of early computed
tomography scans of traumatic brain injured patients and relations to outcome. J 
Neurotrauma. 2010 Jan;27(1):51-64. doi: 10.1089/neu.2009.0986. PubMed PMID:
19698072.
)).
It is also the only scoring system that takes diffuse axonal injury (DAI) visible on CT into consideration
((Nelson DW, Nyström H, MacCallum RM, Thornquist B, Lilja A, Bellander BM,
Rudehill A, Wanecek M, Weitzberg E. Extended analysis of early computed
tomography scans of traumatic brain injured patients and relations to outcome. J 
Neurotrauma. 2010 Jan;27(1):51-64. doi: 10.1089/neu.2009.0986. PubMed PMID:
19698072.
)).
Moreover, the Stockholm CT score remains the only scoring system that is based on many features of CT scans examined prospectively using an extended protocol, to identify information content. The Helsinki CT score is based on components from both the Marshall computed tomography classification and Rotterdam CT score, but additionally focuses more on the types of intracranial injuries present 
((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.
)).
Thus, the Stockholm and Helsinki CT scoring systems more comprehensively analyze different components of the admission CT scan, and have both been shown to be better outcome predictors than the Marshall computed tomography classification and Rotterdam CT score
((Nelson DW, Nyström H, MacCallum RM, Thornquist B, Lilja A, Bellander BM,
Rudehill A, Wanecek M, Weitzberg E. Extended analysis of early computed
tomography scans of traumatic brain injured patients and relations to outcome. J 
Neurotrauma. 2010 Jan;27(1):51-64. doi: 10.1089/neu.2009.0986. PubMed PMID:
19698072.
))
((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.
)).

The Stockholm and Helsinki CT scores provide more information on the damage sustained, and give a more accurate outcome prediction, than earlier classification systems. The strong independent predictive value of tSAH may reflect an underrated component of TBI pathophysiology. A change to these newer CT scoring systems may be warranted
((Thelin EP, Nelson DW, Vehviläinen J, Nyström H, Kivisaari R, Siironen J,
Svensson M, Skrifvars MB, Bellander BM, Raj R. Evaluation of novel computerized
tomography scoring systems in human traumatic brain injury: An observational,
multicenter study. PLoS Med. 2017 Aug 3;14(8):e1002368. doi:
10.1371/journal.pmed.1002368. eCollection 2017 Aug. PubMed PMID: 28771476; PubMed
Central PMCID: PMC5542385.
)).

Marshall [[head computed tomography]] (CT) classification for [[traumatic brain injury]] is widely used as a predictor of outcome. However, this grading system lacks the following variables, which are found to be useful predictors: subarachnoid/intraventricular hemorrhage, extradural hematoma, and extent of basal cistern compression. A new classification called the [[Rotterdam CT score]], incorporating the above variables, was proposed later. 

Both Marshall and [[Rotterdam CT score]] are good in predicting early mortality after moderate and severe TBI
((Mata-Mbemba D, Mugikura S, Nakagawa A, Murata T, Ishii K, Li L, Takase K,
Kushimoto S, Takahashi S. Early CT findings to predict early death in patients
with traumatic brain injury: Marshall and Rotterdam CT scoring systems compared
in the major academic tertiary care hospital in northeastern Japan. Acad Radiol. 
2014 May;21(5):605-11. doi: 10.1016/j.acra.2014.01.017. PubMed PMID: 24703472.)).

As the Rotterdam system also includes additional variables like subarachnoid hemorrhage, it may be preferable, particularly in patients with diffuse injury
((Deepika A, Prabhuraj AR, Saikia A, Shukla D. Comparison of predictability of
Marshall and Rotterdam CT scan scoring system in determining early mortality
after traumatic brain injury. Acta Neurochir (Wien). 2015 Sep 15. [Epub ahead of 
print] PubMed PMID: 26374440.
)).

Use of the novel Helsinki CT score improved outcome prediction accuracy, and the Helsinki CT score is a feasible alternative to the Rotterdam and Marshall CT systems. External validation of the Helsinki CT score is advocated to show generalizability
((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.)).