Helsinki Computed Tomography Scoring System Can Independently Predict Long-Term Outcome in Traumatic Brain Injury.

Abstract

The Helsinki computed tomography (CT) scoring system was developed to predict long-term outcome in patients with traumatic brain injury (TBI) 2 years ago; however, it has not yet been external validated. This study aimed to determine whether this system could be used as an independent predictor for TBI. This retrospective cohort study was performed on 302 consecutive patients with TBI. Univariate and multivariate logistic regressions and receiver operating characteristic curve analyses were used to determine the relationship between initial Helsinki CT scores and mortality and unfavorable neurologic outcome at 6 months after injury. Outcomes were assessed using the Glasgow Outcome Scale (scores of 1-3 defined as unfavorable outcome). Of all patients, mortality was 17.9% and unfavorable outcome was 41.4%. The Helsinki CT score was significantly associated with the 6-month outcome in univariate analyses (P < 0.05). After adjustment for other factors in the multivariate regression analysis, the Helsinki CT score remained an independent predictor for mortality (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.08-1.39; P= 0.002) and unfavorable outcome (OR, 1.14; 95% CI, 1.04-1.26; P= 0.007). Receiver operating characteristic curve analyses showed that the Helsinki CT score possessed good discrimination ability for mortality (area under the curve, 0.81; 95% CI, 0.75-0.87; P < 0.001) and moderate discrimination ability for unfavorable outcome (area under the curve, 0.74; 95% CI, 0.69-0.80; P < 0.001). Moreover, at 1.9 hours after TBI, the Helsinki CT score was most accurate for predicting mortality (accuracy, 74.5%) and unfavorable outcome (accuracy, 71.5%). The Helsinki CT score showed good prognostic discrimination and can be used as an independent predictor for long-term outcome prediction in patients with TBI.