A Retrospective Observation Study: CT Imaging Scoring Systems as Predictors of Mortality in Adults with Traumatic Brain Injury in the Emergency Department of a Tertiary Care Hospital
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Abstract
Background: Traumatic brain injury (TBI) is a major global health challenge, with high rates of morbidity and mortality. Rapid and accurate prognostication in the emergency department is crucial for triage, clinical decision-making, and allocation of resources. Several computed tomography (CT)-based scoring systems have been developed, yet comparative evaluation in Indian tertiary care settings remains limited. Objective: To assess and compare the prognostic accuracy of five widely used CT-based scoring systems- Rotterdam, Helsinki, Stockholm, Marshall, and Neuroimaging Radiological Interpretation System (NIRIS)- for predicting in-hospital and 30-day mortality among TBI patients. Methods: This retrospective observational study included 278 adult TBI patients admitted to the emergency department of a tertiary care center in Ahmedabad, India, during 2024. All underwent non-contrast CT within two hours of arrival. Scans were independently reviewed by neuro-radiologists and scored using the five CT-based systems. Mortality outcomes were analyzed at discharge and 30 days post-injury. Diagnostic performance was assessed using sensitivity, specificity, predictive values, and area under the receiver operating characteristic curve (AUC). Results: The overall 30-day mortality was 15.1% (n=42). Higher scores in all systems correlated with increased mortality (p<0.001). The Stockholm score demonstrated the best performance (specificity 91%, AUC 0.89), followed by the Helsinki score (AUC 0.86). Rotterdam and Marshall scores also showed strong discriminatory ability, while NIRIS was moderately predictive. Diffuse axonal injury, cerebral edema, and midline shift were significant imaging predictors of poor outcome. Conclusion: All five CT-based scoring systems are valid predictors of mortality in TBI patients. The Stockholm and Helsinki scores demonstrated superior prognostic performance and may be incorporated into early emergency department assessment, particularly when combined with clinical variables such as Glasgow Coma Scale. These findings highlight the importance of structured imaging-based scoring for improving early risk stratification and guiding management.
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Copyright (c) 2025 Dr. Nilesh Thanth, Dr. Khushbu Kella, Dr. Dharmistra Dhusa, Dr Bhavesh Jarwani
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.
Dr. Nilesh Thanth, Ird Year Resident, Department of Emergency Medicine, SVPIMSR, SMT. NHLMMC, Ahmedabad, Gujrat, India.
Ird Year Resident, Department of Emergency Medicine, SVPIMSR, SMT. NHLMMC, Ahmedabad, Gujrat, India.
Dr. Khushbu Kella, IInd Year Resident, Department of Emergency Medicine, SVPIMSR, SMT. NHLMMC, Ahmedabad, Gujrat, India.
IInd Year Resident, Department of Emergency Medicine, SVPIMSR, SMT. NHLMMC, Ahmedabad, Gujrat, India.
Dr. Dharmistra Dhusa, Assistant Professor, Department of Emergency Medicine, SVPIMSR, SMT. NHLMMC, Ahmedabad, Gujrat, India.
Assistant Professor, Department of Emergency Medicine, SVPIMSR, SMT. NHLMMC, Ahmedabad, Gujrat, India.
Dr Bhavesh Jarwani, Head of Department, Department of Emergency Medicine, SVPIMSR, SMT. NHLMMC, Ahmedabad-380006, Gujrat, India.
Head of Department, department of emergency medicine, SVPIMSR, smt. NHLMMC, Ahmedabad, Gujrat, India.
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