Rotterdam score of traumatic brain injury (CT)

Notes

The Rotterdam score

The primary aim of the score is to provide an estimated long-term prognosis in patients who sustained traumatic brain injury, at the time of the initial imaging.

The following structures are assessed:

• basal cisterns
  • 0: normal
  • 1: compressed
  • 2: absent
• midline shift
  • 0: none or ≤5 mm
  • 1: shift >5 mm
• epidural mass lesion
  • 0: present
  • 1: absent
• intraventricular blood or traumatic subarachnoid hemorrhage
  • 0: absent
  • 1: present

Plus 1 must be added to the score, thus the total score ranges between 1-6.

^{Maas AI, Hukkelhoven CW, Marshall LF, Steyerberg EW. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery. 2005 Dec;57(6):1173-82; discussion 1173-82. doi: 10.1227/01.neu.0000186013.63046.6b. PMID: 16331165.}

Estimated prognosis

In adults:

• score 1: 0% estimated mortality at 6 months
• score 2: 7%
• score 3: 16%
• score 4: 26%
• score 5: 53%
• score 6: 61%

In children lower (≤3) Rotterdam scores indicate lower mortality, while mortality is higher than in adults with higher scores.

^{Liesemer K, Riva-Cambrin J, Bennett KS, Bratton SL, Tran H, Metzger RR, Bennett TD. Use of Rotterdam CT scores for mortality risk stratification in children with traumatic brain injury. Pediatr Crit Care Med. 2014 Jul;15(6):554-62. doi: 10.1097/PCC.0000000000000150. PMID: 24751786; PMCID: PMC4087067.}

Practical points

An important caveat: contusion bleedings of the brain parenchyma are not included in the Rotterdam score.

In the original study the authors used the first head CT (within 4 hours) and not the worst CT scan during admission for estimating prognosis. Furthermore, patients with mild head injury were not included in the study.

^{Mishra, R., Ucros, H. E. V., Florez-Perdomo, W. A., Suarez, J. R., Moscote-Salazar, L. R., Rahman, Md. M., & Agrawal, A. (2021). Predictive Value of Rotterdam Score and Marshall Score in Traumatic Brain Injury: A Contemporary Review. In Indian Journal of Neurotrauma. Georg Thieme Verlag KG. https://doi.org/10.1055/s-0041-1727404}

Further reading

Radiopaedia.org article

Last updated: 2022-04-04