Computerized Tomography-Based Scoring Systems (Marshall and Rotterdam score) versus Physiological Scoring Systems (GCS and APACHE II score) in Predicting Mortality in Traumatic Brain Injury

Objective: Since traumatic brain injury (TBI) has high mortality rates, it is essential to identify patients with poor prognosis. In this study, the mortality prediction performances of the Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Assessment-II (APACHE-II), Marshall, and Rotterdam scores were compared in patients with TBI in the intensive care unit (ICU) of a tertiary center. Methods: Patients followed up in the ICU due to moderate to severe TBI between January 2020 and January 2022 were retrospectively reviewed. Patients were classified as survivor and nonsurvivor groups. The patient's clinical characteristics and the scoring systems' performance in predicting 28-day mortality were investigated. Results: A total of 150 patients were included in the study, and 82.4% (n=98) were male. GCS scores were significantly lower in the nonsurvivor group, while APACHE-II, Marshall, and Rotterdam scores were significantly higher (p < .001 for all). GCS, APACHE-II, and Rotterdam scores were independent predictors of mortality (p = .002, p = .012, and p = .003, respectively). Receiver operating characteristics curve analysis revealed that GCS cut-off value was ≥6.5, area under the curve (AUC)=0.851, APACHE-II cut-off value was ≥ 21.5, AUC=0.866, Marshall cut-off value was ≥ 3.5, AUC=0.827 and Rotterdam cut-off value was ≥ 3.5, AUC=0.864. Conclusion: GCS, APACHE-II, Marshall, and Rotterdam scores are valid in predicting mortality in patients with TBI. Their performance in predicting mortality is ranked from highest to lowest as APACHE-II, Rotterdam, GCS, and Marshall.