Marshall classification of traumatic brain injury

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 6six 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: 

1. degree of swelling, as determined by A) midline shift and/or B) compression of basal cisterns
2. 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 5mm5 mm
  • basal cisterns remain visible
  • no high or mixed density lesions (contusions) >25cm;25 cm³
• diffuse injury III (swelling)
  • midline shift of 0 to 5mm5 mm
  • basal cisterns compressed or completely effaced
  • no high or mixed density lesions (contusions) >25cm;25 cm³
• diffuse injury IV (shift)
  • midline shift > 5mm 5mm
  • no high or mixed density lesions (contusions) >25cm;25 cm³
• evacuated mass lesion V
  • any lesion evacuated surgically
• non-evacuated mass lesion VVI
  • no high or mixed density lesions (contusions) >25cm;25 cm³
  • ​not surgically evacuated