BACKGROUND The prognosis of penetrating traumatic brain injury (pTBI) is poor yet highly variable. Current computerized tomography (CT) severity scores are commonly not used for pTBI prognostication but may provide important clinical information in these cohorts. METHODS All consecutive pTBI patients from two large neurotrauma databases (Helsinki 1999-2015, Stockholm 2005-2014) were included. Outcome measures were 6-month mortality and unfavorable outcome (Glasgow Outcome Scale 1-3). Admission head CT scans were assessed according to the following: Marshall CT classification, Rotterdam CT score, Stockholm CT score, and Helsinki CT score. The discrimination (area under the receiver operating curve, AUC) and explanatory variance (pseudo-R2) of the CT scores were assessed individually and in addition to a base model including age, motor response, and pupil responsiveness. RESULTS Altogether, 75 patients were included. Overall 6-month mortality and unfavorable outcome were 45% and 61% for all patients, and 31% and 51% for actively treated patients. The CT scores' AUCs and pseudo-R2s varied between 0.77-0.90 and 0.35-0.60 for mortality prediction and between 0.85-0.89 and 0.50-0.57 for unfavorable outcome prediction. The base model showed excellent performance for mortality (AUC 0.94, pseudo-R2 0.71) and unfavorable outcome (AUC 0.89, pseudo-R2 0.53) prediction. None of the CT scores increased the base model's AUC (p > 0.05) yet increased its pseudo-R2 (0.09-0.15) for unfavorable outcome prediction. CONCLUSION Existing head CT scores demonstrate good-to-excellent performance in 6-month outcome prediction in pTBI patients. However, they do not add independent information to known outcome predictors, indicating that a unique score capturing the intracranial severity in pTBI may be warranted.

中文翻译：

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电脑断层扫描评分系统在平民穿透性脑外伤中的预后性能：一项观察性研究。

背景技术穿透性脑外伤（pTBI）的预后很差，但变化很大。当前的计算机断层扫描（CT）严重程度评分通常不用于pTBI的预后，但可能在这些人群中提供重要的临床信息。方法包括来自两个大型神经创伤数据库（Helsinki 1999-2015，Stockholm 2005-2014）的所有连续pTBI患者。结果指标为6个月死亡率和不利结果（格拉斯哥成果量表1-3）。根据以下各项评估入院头颅CT扫描：马歇尔CT分类，鹿特丹CT评分，斯德哥尔摩CT评分和赫尔辛基CT评分。分别评估CT分数的辨别力（接收器工作曲线下的面积，AUC）和解释性方差（伪R2），此外还评估包括年龄，运动反应，和学生的反应能力。结果总共纳入了75例患者。所有患者的总体6个月死亡率和不良结局分别为45％和61％，积极治疗的患者为31％和51％。对于死亡率预测，CT评分的AUC和伪R2在0.77-0.90和0.35-0.60之间变化，对于不良结局预测，CT分数的AUC和伪R2在0.85-0.89和0.50-0.57之间变化。基本模型显示出出色的死亡率表现（AUC 0.94，伪R2 0.71）和不利的结果（AUC 0.89，伪R2 0.53）预测。没有CT评分会增加基本模型的AUC（p> 0.05），但不会增加其假R2（0.09-0.15）的不良结果预测。结论现有的头部CT评分在pTBI患者的6个月预后预测中表现出良好至出色的表现。然而，