• Daddy Mata-Mbemba, Shunji Mugikura, Atsuhiro Nakagawa, Takaki Murata, Kiyoshi Ishii, Li Li, Kei Takase, Shigeki Kushimoto, and Shoki Takahashi.
• Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan.
• Acad Radiol. 2014 May 1;21(5):605-11.

Rationale And ObjectivesComputed tomography (CT) plays a crucial role in early assessment of patients with traumatic brain injury (TBI). Marshall and Rotterdam are the mostly used scoring systems, in which CT findings are grouped differently. We sought to determine the scoring system and initial CT findings predicting the death at hospital discharge (early death) in patients with TBI.Materials And MethodsWe included 245 consecutive adult patients with mild-to-severe TBI. Their initial CT and status at hospital discharge (dead or alive) were reviewed, and both CT scores were calculated. We examined whether each score was related to early death; compared the two scoring systems' performance in predicting early death, and identified the CT findings that are independent predictors of early death.ResultsMore deaths occurred among patients with higher Marshall and Rotterdam scores (both P < .05, Mann-Whitney U test). The areas under the receiver operating characteristic curve (AUCs) indicated that both scoring systems had similarly good discriminative power in predicting early death (Marshall, AUC = 0. 85 vs. Rotterdam, AUC = 0.85). Basal cistern absence (odds ratio [OR] = 771.5, P < .0001), positive midline shift (OR = 56.2, P = .0011), hemorrhagic mass volume ≥25 mL (OR = 12.9, P = .0065), and intraventricular or subarachnoid hemorrhage (OR = 3.8, P = .0395) were independent predictors of early death.ConclusionsBoth Marshall and Rotterdam scoring systems can be used to predict early death in patients with TBI. The performance of the Marshall score is at least equal to that of the Rotterdam score. Thus, although older, the Marshall score remains useful in predicting patients' prognosis.Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

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