Free CME Article: Initial Clinical Scales After Severe TBI

Background: Prediction of clinical course and outcome after severe traumatic brain injury (TBI) is important.

Objective: To examine whether clinical scales (Glasgow Coma Scale [GCS], Injury Severity Score [ISS], and Acute Physiology and Chronic Health Evaluation II [APACHE II]) or radiographic scales based on admission computed tomography (Marshall and Rotterdam) were associated with intensive care unit (ICU) physiology (intracranial pressure [ICP], brain tissue oxygen tension [PbtO₂]), and clinical outcome after severe TBI.

Methods: One hundred one patients (median age, 41.0 years; interquartile range [26-55]) with severe TBI who had ICP and PbtO₂ monitoring were identified. The relationship between admission GCS, ISS, APACHE II, Marshall and Rotterdam scores and ICP, PbtO₂, and outcome was examined by using mixed-effects models and logistic regression.

Ahead of Print: Rotterdam Score in Craniectomized Patients

Background: The Rotterdam computed tomography (CT) score was developed for prognostic purposes in traumatic brain injury (TBI).

Objective: To examine the prognostic discrimination and prediction of the Rotterdam CT score in the case of patients undergoing decompressive craniectomy (DC) for TBI.

Methods: The worst CT scans before DC were scored according to the Rotterdam CT classification. Mortality and Glasgow Outcome Scale (GOS) at the end of follow-up were used as outcome measures. Unfavorable and favorable outcomes were defined by a GOS score of 1-3 and 4-5, respectively. We used binary logistic and proportional odds regression for prognostic analyses.