Modified Revised Trauma–Marshall score as a proposed tool in predicting the outcome of moderate and severe traumatic brain injury

Tjokorda Gde Bagus Mahadewa,1 Nyoman Golden,1 Anne Saputra,1 Christopher Ryalino2 1Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia; 2Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia Background: Traumatic brain injury (TBI) is a common healthcare problem related to disability. An easy-to-use trauma scoring system informs physicians about the severity of trauma and helps to decide the course of management. The purpose of this study is to use the combination of both physiological and anatomical assessment tools that predict the outcome and develop a new modified prognostic scoring system in TBIs. Patients and methods: A total of 181 subjects admitted to the emergency department (ED) of Sanglah General Hospital were documented for both Marshall CT scan classification score (MCTC) and Revised Trauma Score (RTS) upon admission. Glasgow Outcome Scale (GOS) was then documented at six months after brain injury. A new Modified Revised Trauma–Marshall score (m-RTS) was developed using statistical analytic methods. Results: The total sample enrolled for this study was 181 patients. The mean RTS upon admission was 10.2±1.2. Of the 181 subjects, 110 (60.8%) were found to have favorable GOS (GOS score >3). Best Youden’s index results were obtained with any of the RTS of ≤10 with area under receiver operating characteristic (ROC) curve of 0.2542 and with risk ratio of 2.9 (95% CI=1.98−4.28; P=0.001); and Marshall score ≤2 with area under ROC curve of 0.2249 with risk ratio of 3.9 (95% CI=2.52−5.89; P=0.001). The RTS–Marshall combination has higher sensitivity with risk ratio of 4.5 (CI 95%=2.55−8.0; P=0.001) for screening tools of unfavorable outcome. The Pearson’s correlation between RTS and Marshall classification is 0.464 (P<0.001). Conclusion: Combination of physiological and anatomical score improves the prognostic of outcome in moderate and severe TBI patients, formulated in this accurate, simple, applicable and reliable m-RTS prognostic score model. Keywords: head injury, CT scan, revised score, prognostic scor