Predicting outcomes of decompressive craniectomy: use of Rotterdam Computed Tomography Classification and Marshall Classification

Background Data on the evaluation of the Rotterdam Computed Tomography Classification (RCTS) as a predictor of outcomes in patients undergoing decompressive craniectomy (DC) for trauma is limited and lacks clarity. Objective To explore the role of RCTS in predicting unfavourable outcomes, including mortality in patients undergoing DC for head trauma. Methods This was an observational cohort study conducted from 1 January 2009 to 31 March 2013. CT scans of adults with head trauma prior to emergency DC were scored according to RCTS. A receiver operating characteristic curve analysis was performed to identify the optimal cut-off RCTS for predicting unfavourable outcomes [Glasgow outcome scale (GOS)=1-3]. Binary logistic regression analysis was performed to evaluate the relationship between RCTS and unfavourable outcomes including mortality. Results One hundred ninety-seven patients (mean age: 31.4 +/- 18.7 years) were included in the study. Mean Glasgow coma score at presentation was 8.1 +/- 3.6. RCTS was negatively correlated with GOS (r=-0.370; p<0.001). The area under the curve was 0.687 (95% CI: 0.595-0.779; p<0.001) and 0.666 (95% CI: 0.589-0.742; p<0.001) for mortality and unfavourable outcomes, respectively. RCTS independently predicted both mortality (adjusted odds ratio for RCTS>3 compared with RCTS3: 2.792, 95% CI: 1.235-6.311) and other unfavourable outcomes (adjusted odds ratio for RCTS>3 compared with RCTS3: 2.063, 95% CI: 1.056-4.031). Conclusion RCTS is an independent predictor of unfavourable outcomes and mortality among patients undergoing emergency DC.