Background: Traumatic brain injury (TBI) is a major cause of mortality and long-term neurological disability worldwide. Computed tomography (CT)-based prognostic models, including the Marshall CT Classification and Rotterdam CT Score, are commonly used to assess injury severity and predict outcomes. However, their comparative accuracy in predicting mortality remains uncertain, particularly in middle-income settings. Objective: To compare the predictive performance of the Marshall and Rotterdam CT scoring systems for early in-hospital mortality among patients with TBI. Methods: This retrospective cohort study included 320 adults (≥18 years) with CT-confirmed TBI admitted to a tertiary trauma center between January 2019 and December 2022. Admission CT scans were independently scored using both systems. The primary outcome was all-cause in-hospital mortality within 14 days. Discriminative ability was evaluated using receiver operating characteristic (ROC) analysis and area under the curve (AUC), while calibration was assessed using the Hosmer-Lemeshow test. Results: Overall mortality was 27.2% (87/320). The Rotterdam CT score demonstrated superior discrimination for mortality prediction compared with the Marshall classification (AUC 0.847, 95% CI 0.801–0.893 vs. 0.779, 95% CI 0.724–0.834; p=0.003). A Rotterdam score ≥4 yielded 82.8% sensitivity and 75.2% specificity. Multivariable logistic regression identified Rotterdam score (OR 2.14, 95% CI 1.67–2.74; p60 years (OR 2.89, 95% CI 1.54–5.41; p=0.001) as independent predictors of mortality. Conclusion: The Rotterdam CT score provides significantly better prognostic accuracy for early in-hospital mortality in TBI patients than the Marshall CT classification. Its incorporation of additional radiological variables may enhance risk stratification and support its use as the preferred CT-based prognostic tool in clinical practice and research.
Khaliq et al. (Sat,) studied this question.