Background: Data on the evaluation of The Rotterdam Computed Tomography Score (RCTS) as a predictor of outcomes in patients undergoing decompressive craniectomy (DC) for trauma is limited and lacks clarity. Objective: To explore the role of RCTS in predicting unfavorable outcomes, including mortality in patients undergoing DC for head trauma.

Methods: This was an observational cohort study conducted from January I, 2009 to March 31, 2013. CT scans of adults with head trauma prior to emergency DC were scored according to RCTS. A receiver operating characteristic curve analysis was performed to identify the optimal cutoff RCTS for predicting unfavorable outcomes [Glasgow outcome scale (GOS) =1-3]. Binary logistic regression analysis was performed to evaluate the relationship between RCTS and unfavorable outcomes including mortality.

Results: 197 patients (mean age: 31.4 ± 18.7 years) were included in the study. Mean GCS at presentation was 8.1 ± 3.6. RCTS was negatively correlated with GOS (r = -0.370, p < 0.001). The area under the curve was 0.687 (95 % CI 0.595- 0.779, p < 0.001,) and 0.666 (and 95 % CI 0.589 – 0.742; p < 0.001) for mortality and unfavorable outcomes, respectively. RCTS independently predicted both mortality (adjusted odds ratio for RCTS >3 compared with RCTS ≤ 3: 2.792, 95% CI 1.235-6.311) and other unfavorable outcomes (adjusted odds ratio for RCTS >3 compared with RCTS ≤ 3: 2.063, 95% CI 1.056-4.031).

Conclusion: RCTS is an independent predictor of unfavorable outcomes and mortality among patients undergoing emergency DC.

Keywords: Rotterdam score, Traumatic Brain Injury, Decompressive Crniectomy, Unfavorable outcomes