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Dynamics of brain tissue changes induced by traumatic brain injury assessed with the Marshall, Morris–Marshall, and the Rotterdam classifications and its impact on outcome in a prostacyclin placebo-controlled study

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Abstract

Background

The present study evaluates the types and dynamics of intracranial pathological changes in patients with severe traumatic brain injury (sTBI) who participated in a prospective, randomized, double-blinded study of add-on treatment with prostacyclin. Further, the changes of brain CT scan and their correlation to Glasgow Coma Scale score (GCS), maximal intracranial pressure (ICPmax), minimal cerebral perfusion pressure (CPPmin), and Glasgow Outcome Score (GOS) at 3, 6, and 12 months were studied.

Methods

Forty-eight subjects with severe traumatic brain injury were treated according to an ICP-targeted therapy protocol based on the Lund concept with the addition of prostacyclin or placebo. The first available CT scans (CTi) and follow-up scans nearest to 24 h (CT24) were evaluated using the Marshall, Rotterdam, and Morris–Marshall classifications.

Results

There was a significant correlation of the initial Marshall, Rotterdam, Morris–Marshall classifications and GOS at 3 and 12 months. The CT24 Marshall classification did not significantly correlate to GOS while the Rotterdam and the Morris–Marshall classification did. The CTi Rotterdam classification predicted outcome evaluated as GOS at 3 and 12 months. Prostacyclin treatment did not influence the dynamic of tissue changes.

Conclusions

The Rotterdam classification seems to be appropriate for describing the evolution of the injuries on the CT scans and contributes in predicting of outcome in patients treated with an ICP-targeted therapy. The Morris–Marshall classification can also be used for prognostication of outcome but it describes only the impact of traumatic subarachnoid hemorrhage (tSAH).

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Acknowledgments

This study was financially supported by grants from the Foundation for Clinical Neuroscience at Umeå University, collecting Foundation at Umeå University, Kempe Foundation, Carnegie Research Foundation, and Capio Research Foundation, which is gratefully acknowledged.

Author Disclosure Statement

All listed authors were involved in writing the manuscript. There are no ethical conflicts to be considered. No competing financial interests exist.

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Authors and Affiliations

  1. Department of Pharmacology and Clinical Neuroscience, Division of Neurosurgery, Umeå University, SE 901 85, Umeå, Sweden

    Lukas Bobinski, Magnus Olivecrona & Lars-Owe D. Koskinen

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  1. Lukas Bobinski
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  2. Magnus Olivecrona
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  3. Lars-Owe D. Koskinen
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Correspondence to Lukas Bobinski.

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Bobinski, L., Olivecrona, M. & Koskinen, LO.D. Dynamics of brain tissue changes induced by traumatic brain injury assessed with the Marshall, Morris–Marshall, and the Rotterdam classifications and its impact on outcome in a prostacyclin placebo-controlled study. Acta Neurochir 154, 1069–1079 (2012). https://doi.org/10.1007/s00701-012-1345-x

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