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

Figures & data

Table 1 Subject characteristics

Variables	n= 181
Age (year), mean±SD	39.4±18.3
Sex, n (%)
° Male	131 (72.4)
° Female	50 (27.6)
Intracranial lesion, n (%)
° Epidural hematoma	41 (22.7)
° Subdural hematoma	48 (26.5)
° Intracranial hemorrhage	57 (31.5)
° Subarachnoid hemorrhage	17 (9.4)
° Diffuse axonal injury	17 (9.4)
° Intra ventricular hemorrhage	1 (0.5)
Management, n (%)
° Conservative	91 (50.3)
° Surgical	90 (49.7)
Diameter of pupils, n (%)
° Isochoric	155 (85.6)
° Anisochoric	20 (11.1)
° Bilateral dilated	6 (3.3)
Pupillary light reflex, n (%)
° Response	151 (83.4)
° Late response	21 (11.6)
° Unresponsive	9 (5)
Mechanism of injury, (%)
° Traffic accident	151 (83.4)
° Workplace accident nor related to traffic	11 (6.1)
° Falls	9 (4.9)
° Unknown	5 (2.8)
° Others	5 (2.8)

Table 2 RTS, Marshall score, and GOS assessment characteristics

Variables	n= 181
GCS, mean±SD	8.3±2.8
0 (3)	13 (7.2%)
1 (4–5)	29 (16%)
2(6–8)	17 (9.4%)
3 (9–12)	122 (67.4%)
Respiratory rate, mean±SD	21.4±3.5
3 (>29 x/minute)	20 (11.1%)
4 (10–29 x/minute)	161 (88.9%)
Systolic blood pressure, mean±SD	122.3±25.1
2 (50–75 mmHg)	4 (2.2%)
3 (76–89 mmHg)	2 (1.1%)
4 (>89 mmHg)	175 (96.7%)
RTS, mean±SD	10.2± 1.2
Marshall classification CT scan, n (%)
1 (Non evacuated mass lesion)	11 (6.1)
2 (Diffuse injury IV/evacuated mass)	61 (33.7)
3 (Diffuse injury III)	36 (19.9)
4 (Diffuse injury II)	60 (33.1)
5 (Diffuse injury I)	13 (7.2)
GOS, n (%)
1 (Death)	66 (36.5)
2 (Vegetative state)	1 (0.6)
3 (Severe disability)	4 (2.2)
4 (Moderate disability)	17 (9.4)
5 (Good recovery)	93 (51.4)
GOS, n (%)
Good–moderate (favorable)	110 (60.8)
Severe, vegetative and death (unfavorable)	71 (39.2)

Abbreviations: GCS, Glasgow Coma Scale; GOS, Glasgow Outcome Scale; RTS, Revised Trauma Score.

Figure 1 ROC analysis of RTS to GOS (left) and ROC analysis of Marshall score to GOS (right).

Abbreviations: GOS, Glasgow Outcome Scale; RTS, Revised Trauma Score; ROC, receiver operating characteristic.

Table 3 Sensitivity, specificity, positive predictive value, and negative predictive value of RTS, Marshall score, and RTS–Marshall combination to unfavorable GOS

	RR	Sensitivity, %	Specificity, %	PPV, %	NPV, %	Accuracy, %
RTS	2.9	64.8	78.2	65.7	77.5	72.9
Marshall score	3.9	71.8	80.9	70.8	81.7	77.3
Combination of both	4.5	84.5	64.5	60.7	86.6	72.4

Abbreviations: GOS, Glasgow Outcome Scale; NPV, negative predictive value; PPV, positive predictive value; RTS, Revised Trauma Score.

Table 4 Pearson’s correlation of RTS to Marshall’s CT scan classification

Variables	R	P-value
RTS	0.464	<0.001
CT scan Marshall

Abbreviation: RTS, Revised Trauma Score.

Table 5 Logistic regression model of RTS-Marshall combination and GOS

	β	95% CI	P-value	R^2
RTS	0.559	0.360–0.758	<0.001	33.45%
MCTC	0.600	0.383–0.817	<0.001
Constant	-4.126	-6.060–2.191	<0.001

Abbreviations: GOS, Glasgow Outcome Scale; MCTC, Marshall CT scan classification score; RTS, Revised Trauma Score.