Day-of-Injury Computed Tomography and Longitudinal Rehabilitation Outcomes: A Comparison of the Marshall and Rotterdam Computed Tomography Scoring Methods.
Kayla M Frodsham, Joseph E Fair, R Brock Frost and 11 others
PMID 32195734WHAT IT FOUND
Marshall and Rotterdam CT scores did not predict functional recovery at rehab discharge or later.
They did predict rehab stay, but no single CT score clearly separated from the others.
Key findings
01Neither the Marshall nor the Rotterdam CT scale as a whole significantly predicted FIM outcomes.
02Both CT scales predicted rehabilitation length of stay, but pairwise comparisons found no significant differences between individual CT scores.
03In full models, age and FIM motor at rehabilitation admission predicted FIM motor at discharge; FIM cognitive at admission and a Rotterdam score of 5 compared with 2 predicted FIM cognitive at discharge.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study had 88 participants, which was not enough to detect a small effect with power of 0.8. Twenty-three participants did not return for nine-month follow-up, and missing follow-up data were omitted from analyses. The FIM may have a ceiling effect after discharge, limiting variance in the outcome measure. Length of stay may have been influenced by financial resources and healthcare coverage, not only injury severity. Inter-rater reliability for Rotterdam scores was 0.61, which could weaken its ability to predict outcomes. Diffuse axonal injury and later secondary insults were not included because magnetic resonance and surgery data were too limited for analyses. Patients with brainstem lesions were excluded, so results may not apply to those with more severe brainstem injuries.
Declared interests
The authors declared no conflicts of interest. The article is listed as supported by NIH and non-U.S. government research, but the text does not state a sponsor role.
The easy way to misread this
Do not read the length-of-stay finding as evidence that CT scores predict functional recovery. The primary FIM motor and cognitive outcomes were not predicted by either scale, and pairwise comparisons did not show significant differences among individual CT scores.