Predictive utility of an adapted Marshall head CT classification scheme after traumatic brain injury.
Allen W Brown, Christopher R Pretz, Kathleen R Bell and 11 others
PMID 30663426WHAT IT FOUND
An adapted Marshall CT classification did not meaningfully predict injury severity or functional outcomes after moderate-severe TBI.
It only helped predict whether acute surgery was done, so it should not guide long-term rehabilitation prognosis.
Key findings
01The adapted Marshall CT classification did not meaningfully contribute to models predicting outcomes at any time point after injury.
02The classification aided prediction only of whether craniotomy or craniectomy was performed during acute hospitalization.
03At rehabilitation discharge, time to follow commands and age were the strongest contributors, and at 1 year, age and rehabilitation length of stay were the strongest contributors.
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 findings apply only to people with TBI admitted for inpatient rehabilitation, not to those who do not receive acute inpatient rehabilitation or are not hospitalized. The adapted Marshall classification omitted several CT findings, including high- or mixed-density lesions greater than 25 cc, surgically evacuated lesions, contusion locations, extra-axial blood, and intracranial fragments. Glasgow Coma Scale scores were missing for one-half of the sample and were not used. About 18% of participants were lost to follow-up at 1 year. CT techniques and interpretations were not standardized, and outcomes were measured at rehabilitation admission and discharge, which do not occur at fixed times after injury.
Declared interests
The authors reported no potential conflict of interest.
The easy way to misread this
Do not conclude that head CT is useless after TBI. This study tested only an adapted Marshall classification that omitted several CT findings, and it still helped predict whether acute surgery was done.