© 2018 Mahadewa et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Open Access Emergency Medicine 2018:10 135–139 Open Access Emergency Medicine Dovepress submit your manuscript | www.dovepress.com Dovepress 135 OriginAl rEsEArch open access to scientific and medical research Open Access Full Text Article http://dx.doi.org/10.2147/OAEM.S179090 Modifed Revised Trauma–Marshall score as a proposed tool in predicting the outcome of moderate and severe traumatic brain injury Tjokorda Gde Bagus Mahadewa 1 Nyoman Golden 1 Anne Saputra 1 Christopher Ryalino 2 1 Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia; 2 Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia Background: Traumatic brain injury (TBI) is a common healthcare problem related to disabil- ity. An easy-to-use trauma scoring system informs physicians about the severity of trauma and helps to decide the course of management. The purpose of this study is to use the combination of both physiological and anatomical assessment tools that predict the outcome and develop a new modified prognostic scoring system in TBIs. Patients and methods: A total of 181 subjects admitted to the emergency department (ED) of Sanglah General Hospital were documented for both Marshall CT scan classification score (MCTC) and Revised Trauma Score (RTS) upon admission. Glasgow Outcome Scale (GOS) was then documented at six months after brain injury. A new Modified Revised Trauma–Marshall score (m-RTS) was developed using statistical analytic methods. Results: The total sample enrolled for this study was 181 patients. The mean RTS upon admis- sion was 10.2±1.2. Of the 181 subjects, 110 (60.8%) were found to have favorable GOS (GOS score >3). Best Youden’s index results were obtained with any of the RTS of ≤10 with area under receiver operating characteristic (ROC) curve of 0.2542 and with risk ratio of 2.9 (95% CI=1.98-4.28; P=0.001); and Marshall score ≤2 with area under ROC curve of 0.2249 with risk ratio of 3.9 (95% CI=2.52-5.89; P=0.001). The RTS–Marshall combination has higher sensitivity with risk ratio of 4.5 (CI 95%=2.55-8.0; P=0.001) for screening tools of unfavorable outcome. The Pearson’s correlation between RTS and Marshall classification is 0.464 (P<0.001). Conclusion: Combination of physiological and anatomical score improves the prognostic of outcome in moderate and severe TBI patients, formulated in this accurate, simple, applicable and reliable m-RTS prognostic score model. Keywords: head injury, CT scan, revised score, prognostic score Introduction Traumatic brain injury (TBI) is a major global public health problem. In the USA alone, the Centers for Disease Control and Prevention reports that at least 1.7 million people sustain TBIs each year. 1 Out of these, 50,000 will die and many more will join the estimated 5.3 million Americans living with TBI-related disabilities. 2 Associated long-term physical, cognitive, and psychological disturbances can affect survivors’ ability to live and work independently. Trauma is a time-sensitive condition and recognized as one of the main chal- lenges in modern healthcare. 3 Easy-to-use trauma scoring systems inform physicians of the severity of the trauma in patients and help them to decide the course of trauma management. 4 Scoring systems can also be used for clinical decision-making when a Correspondence: Tjokorda Gde Bagus Mahadewa Department of Surgery, Udayana University/Sanglah General Hospital, Bali, Jl. Diponegoro, Denpasar, Bali 80113, Indonesia Tel +62 36 122 2510 Email tjokbagusmahadewa@gmail.com Open Access Emergency Medicine downloaded from https://www.dovepress.com/ by 54.161.69.107 on 04-Jun-2020 For personal use only. 1 / 1