Traumatic brain injury (TBI) is a leading cause of mortality and long-term disability in children globally. Consequently, clinicians rely heavily on initial imaging to guide management and counsel families. Researchers recently evaluated the effectiveness of various pediatric TBI CT scales to determine which scoring system offers the most reliable prognosis at the time of hospital discharge.

The retrospective cohort study analyzed 295 pediatric patients admitted to a tertiary intensive care unit. Researchers specifically compared four established classification systems: the Marshall, Rotterdam, Helsinki, and Stockholm scales. To measure functional results, the team used the Extended Glasgow Outcome Scale Pediatric Revision (GOS-E Peds). Most patients in the study fell into lower-risk categories, with 84.4% achieving a good recovery by discharge.

Performance of Various Pediatric TBI CT Scales

The study utilized multivariable penalized logistic regression to assess the predictive accuracy of each scale. Although all four systems showed significant associations with outcomes in univariable analysis, their performance varied significantly in more complex models. Specifically, the Stockholm score demonstrated the highest discriminative ability with an AUROC of 0.889. In contrast, the Marshall (0.829) and Helsinki (0.761) scales followed, while the Rotterdam score showed the lowest performance (0.685). Furthermore, all scales except the Rotterdam classification remained independent predictors in the final multivariable model.

These findings suggest that weighted, multidimensional classifications like the Stockholm score provide superior prognostic information. This superiority likely stems from the inclusion of more granular data, such as traumatic subarachnoid hemorrhage and midline shift volume. However, the authors emphasize that multicenter validation is still required to confirm these results across diverse populations. Therefore, while these tools are helpful, clinical judgment remains paramount in managing complex pediatric cases.

Frequently Asked Questions

Why did the Stockholm score perform better than the Marshall or Rotterdam scales?

The Stockholm score is more multidimensional and uses continuous variables for certain features, such as the degree of midline shift. This allows for a more nuanced representation of brain injury compared to the categorical approach used in older systems like the Marshall scale.

What is the GOS-E Peds scale?

The GOS-E Peds is a standardized tool used to assess functional outcomes in children after a brain injury. It evaluates various aspects of daily life, including social participation, independence, and the presence of neurological deficits, specifically tailored for pediatric developmental stages.

Can these CT scales replace clinical assessment?

No, these scales are adjunct tools intended to support clinical decision-making. While they provide valuable prognostic data, clinicians must always consider the patient's entire clinical picture, including GCS scores and physiological stability.

Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

García-Arellano M et al. Comparative performance of CT scales for outcome prediction at discharge in pediatric traumatic brain injury: a retrospective cohort study. J Neurosurg Pediatr. 2026 Apr 17. doi: 10.3171/2025.12.PEDS25520. PMID: 41996717.

Thelin EP, et al. Selection of CT variables and prognostic models for outcome prediction in patients with traumatic brain injury. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2021;29(1):94.

Waheed S, et al. Use of Rotterdam CT Scores for Mortality Risk Stratification in Children with Traumatic Brain Injury. Pediatric Critical Care Medicine. 2018;19(5):445-451.