Kashan University of Medical Sciences
Despite advances in modern medicine, traumatic brain injury is still a major medical problem. Early diagnosis of brain trauma is crucial for clinical decision making and prognosis. The aim of this study was to compare the predictive value of Helsinki, Rotterdam and Stockholm CT scans in predicting late outcomes in patients with brain trauma.
Material and Methods:
In this predictive value study, 171 people with an age range of 24 to 64 years with traumatic brain injury (TBI) who are referred to the surgical emergency department of Shahid Beheshti Hospital in Kashan from the beginning of 2019 to the end of 2020 were studied. Demographic information and CT scan of patients were extracted from the recorded patient information and PACS system. Helsinki, Rotterdam and Stockholm CT scores were determined simultaneously according to available guidelines. Information related to patients’ 6-month outcome was assessed by the extended Glasgow Outcome Scale (GOSE).
The results of this study showed that the mean of Helsinki, Rotterdam and Stockholm CT scores and GOSE in terms of GCS status of brain trauma patients showed a statistically significant difference (P<0.001). This result is significant as higher scores were observed in Helsinki, Rotterdam and Stockholm scores in lower GCSs and higher scores in GOSE scores in higher GCSs. Also, there was a statistically significant difference between the mean of these CT scores and GOSE in terms of mortality and vegetative status of TBI patients (P<0.001). This significance was such that by considering the CT scores in the condition of death and vegetation, higher scores were shown, but in the GOSE, the score was lower. Analysis of Cohen’s Kappa coefficient showed a statistically significant difference between each pair of scores and Stockholm and Helsinki scores had the highest kappa coefficient in predicting patients’ outcomes. In the prediction of mortality outcomes of TBI patients, the Rotterdam CT score showed the highest sensitivity (0.9) among other scores and Helsinki score showed the highest sensitivity (0.898) in predicting 6-month unfavorable outcome.
In the present study, we found that among the three CT scores evaluated, the Rotterdam CT score in predicting mortality of patients with brain trauma was more sensitive and the Helsinki CT score was more specific than other scores. At 6 months outcome, the Helsinki CT score were more sensitive than other scores and the Stockholm CT score was more specific.
Traumatic brain injury (TBI), Rotterdam CT score, Helsinki CT score, Stockholm CT score, CT scan, extended Glasgow Outcome Scale (GOSE)