Neurosurgery notes/Trauma/Head Trauma general/TBI classification/The extent of structural damage (CT classification)

The extent of structural damage (CT classification)

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TBI classification
  • The extent of structural damage is best assessed by neuroimaging.
  • MRI more sensitive than CT
  • CT remains the best due to
    • Its sensitivity for detecting intracranial hematoma
    • The speed,
    • Availability,
    • Safety of examination.
  • Marshall Classification: (Marshall et al., 1991)
    • Extent of structural damage on the CT
        • notion image
          Marshall class
          Mortality
          Class 1: Diffuse injury I (no visible pathology)
          6.4%
          Class 2: Diffuse injury II
          11%
          Class 3: Diffuse injury III (swelling)
          29%
          Class 4: Diffuse injury IV (shift)
          44%
          Class 5: Evacuated mass lesion
          30%
          Class 6: Non-evacuated mass lesion
          34%
  • Rotterdam CT score of traumatic brain injury
    • Classification
      • Basal cisterns:
        • Normal: 0
        • Compressed: 1
        • Absent: 2
      • Midline shift
        • No shift or <= 5 mm: 0
        • Shift > 5 mm: 1
      • Epidural mass lesion
        • Present: 0
        • Absent : 1
      • Intraventricular blood or traumatic SAH
        • Absent: 0
        • Present: 1
    • Prognosis In adults the mortality at six months increases with the score (Score 1 is actually 0 from the Rotterdam classification)
      • Score 1: 0%
      • Score 2: 7%
      • Score 3: 16%
      • Score 4: 26%
      • Score 5: 53%
      • Score 6: 61%
    • Better than marshal classification