Marshall classification of traumatic brain injury
Updates to Article Attributes
Body
was changed:
The Marshall classification of traumatic brain injury is a CT scan derived metric using only a few features, and has been shown to predict outcome in patients with traumatic brain injury.
This system was first published in 1992 1 building on findings from a large cohort of head injury cases described in 1990 2, and at the time of writing (June 2016) remains one of most commonly used systems for grading acute traumatic brain injury on the basis of CT findings. The Rotterdam score is a more recent system, which attempts to address some of the recognised limitations of the Marshall system, such as struggling to classifying patients who have injuries of multiple types 3-5.
Structure
The Marshal system places patients into one of 6 categories (I to VI) of increasing severity (decreased prognosis and survival) on the basis of findings on non-contrast CT scan of the brain. It is primarily concerned with two features:
- degree of swelling, as determined by A) midline shift and/or B) compression of basal cisterns
- presence and size of contusions/haemorrhages (referred to "high or mixed density lesions"
Classification
-
diffuse injury I (no visible pathology)
- no visible intracranial pathology
-
diffuse injury II
- midline shift of 0 to 5mm
- basal cisterns remain visible
- no high or mixed density lesions (contusions) >25cm3
-
diffuse injury III (swelling)
- midline shift of 0 to 5mm
- basal cisterns compressed or completely effaced
- no high or mixed density lesions (contusions) >25cm3
-
diffuse injury IV (shift)
- midline shift > 5mm
- no high or mixed density lesions (contusions) >25cm3
-
evacuated mass lesion V
- any lesion evacuated surgically
-
non-evacuated mass lesion V
- no high or mixed density lesions (contusions) >25cm3
- not surgically evacuated
-<p>The <strong>Marshall classification of traumatic brain injury</strong> is a CT scan derived metric</p><p>This system was first published in 1992 <sup>1</sup> building on findings from a large cohort of head injury cases described in 1990 <sup>2</sup>, and at the time of writing (June 2016) remains one of most commonly used systems for grading acute traumatic brain injury on the basis of CT findings. The <a title="Rotterdam score of traumatic brain injury" href="/articles/rotterdam-score-of-traumatic-brain-injury">Rotterdam score</a> is a more recent system, which attempts to address some of the recognised limitations of the Marshall system, such as struggling to classifying patients who have injuries of multiple types <sup>3</sup>. </p><h4>Classification</h4><ul>- +<p>The <strong>Marshall classification of traumatic brain injury</strong> is a CT scan derived metric using only a few features, and has been shown to predict outcome in patients with traumatic brain injury. </p><p>This system was first published in 1992 <sup>1</sup> building on findings from a large cohort of head injury cases described in 1990 <sup>2</sup>, and at the time of writing (June 2016) remains one of most commonly used systems for grading acute traumatic brain injury on the basis of CT findings. The <a href="/articles/rotterdam-score-of-traumatic-brain-injury">Rotterdam score</a> is a more recent system, which attempts to address some of the recognised limitations of the Marshall system, such as struggling to classifying patients who have injuries of multiple types <sup>3-5</sup>. </p><h4>Structure</h4><p>The Marshal system places patients into one of 6 categories (I to VI) of increasing severity (decreased prognosis and survival) on the basis of findings on non-contrast CT scan of the brain. It is primarily concerned with two features: </p><ol>
- +<li>degree of swelling, as determined by A) midline shift and/or B) compression of basal cisterns</li>
- +<li>presence and size of contusions/haemorrhages (referred to "high or mixed density lesions"</li>
- +</ol><h4>Classification</h4><ul>
References changed:
- 5. Mata-Mbemba D, Mugikura S, Nakagawa A et-al. Early CT findings to predict early death in patients with traumatic brain injury: Marshall and Rotterdam CT scoring systems compared in the major academic tertiary care hospital in northeastern Japan. Acad Radiol. 2014;21 (5): 605-11. <a href="http://dx.doi.org/10.1016/j.acra.2014.01.017">doi:10.1016/j.acra.2014.01.017</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/24703472">Pubmed citation</a><span class="auto"></span>
- 1. Marshall LF, Marshall SB, Klauber MR et-al. The diagnosis of head injury requires a classification based on computed axial tomography. J. Neurotrauma. 1992;9 Suppl 1: S287-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1588618">Pubmed citation</a><span class="auto"></span>
- 2. Eisenberg HM, Gary HE, Aldrich EF et-al. Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J. Neurosurg. 1990;73 (5): 688-98. <a href="http://dx.doi.org/10.3171/jns.1990.73.5.0688">doi:10.3171/jns.1990.73.5.0688</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/2213158">Pubmed citation</a><span class="auto"></span>
- 3. Saatman KE, Duhaime AC, Bullock R et-al. Classification of traumatic brain injury for targeted therapies. J. Neurotrauma. 2008;25 (7): 719-38. <a href="http://dx.doi.org/10.1089/neu.2008.0586">doi:10.1089/neu.2008.0586</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2721779">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/18627252">Pubmed citation</a><span class="auto"></span>
- 4. Munakomi S, Bhattarai B, Srinivas B et-al. Role of computed tomography scores and findings to predict early death in patients with traumatic brain injury: A reappraisal in a major tertiary care hospital in Nepal. Surg Neurol Int. 2016;7 (1): 23. <a href="http://dx.doi.org/10.4103/2152-7806.177125">doi:10.4103/2152-7806.177125</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4774167">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/26981324">Pubmed citation</a><span class="auto"></span>
Systems changed:
- Central Nervous System
Unable to process the form. Check for errors and try again.