Modified Revised-Marshal Score

New Scoring system of TBI, combining anatomic-Physiologic

1. Anne Saputra Mahadewa TG, Golden N Department of Surgery, Faculty of Medicine Udayana University Sanglah General Hospital, Bali

2. INTRODUCTION Traumatic Brain Injury (TBI) Severe TBI mortality 50% (Bullock 2011) Indonesia: (RSCM, PERDOSSI 2009) Severe 35-50% Moderate 5-10% RSUP Sanglah , Bali: > 2000 cases a year 30% severe TBI DECISION OF SURGERY ? Do I need to operate? When should to operate? Prognostic score model ANATOMICAL & PHYSIOLOGICAL

3. Prognostic Analysis Traumatic Brain Injury (TBI) Yes Yes

4. Trauma Scoring TBI Anatomy Mechanism RTS Marshall GOS GCS Sistolic Blood Pressure (mmHg) Respiration rate (times/min) Scoring code 13-15 >89 10-29 4 9-12 76-89 >29 3 6-8 50-75 6-9 2 4-5 1-49 1-5 1 3

5. RTS (Physiological) Statistic RTSc = 0.9368 GCSc + 0.7326 SBPc + 0.2908 RRc Chawda , M.N. 2004. Predicting Outcome After Multiple Trauma: Which Scoring System? The International Journal of The Care of The Injured ; 35: 347-358.

6. CT Abnormality (Anatomical) Statistic Winn, R. 2017. Youmans & Winn Neurological Surgery (7th ed ) in Clinical pathophysiology of traumatic brain injury

7. Marshall Classification TBI Anatomy Mechanism RTS Marshall GOS Marshall et al , 1991

8. CONCEPT of IDEA Prognosis TBI PHYSIOLOGY: GCS Hypotension Hypoxia ANATOMY: Imaging Brain CT scan RTS Marshall Both have correlation with outcome 1. COMBINATION??? 2. Improved Outcome???

9. METHODS Prospective observational approved by Committee of ethical study on 181 patients at ER dept in 2017 Eligible patients of Moderate / Severe TBI Both Marshall & RTS were recorded in the first 60 min Exclude : Respiratory , cardiogenic , neoplasma and multiple trauma Outcome : GOS 6 months Analyzed using SPSS 16.0, p <0.05

10. OUTCOME TBI Anatomy Mechanism RTS Marshall Outcome

11. Characteristic variables of RTS Mean 8.3 ± 2.8 Mean 21.4 + 3.5 Mean 122.3 + 25.1

12. Characteristic variables Marshall

13. GOS Outcome

14. ROC analysis

15. SINGLE Vs COMBINATION

16. Correlation & Linier Regretion

17. NOVELTY Modified Revised Trauma-Marshall score = (0.56 x RTS) + (0.6 x Marshall) – 4,1

18. CONCLUTION END POINT : 1. Combination results in higher sensitivity and proved to increase validity in predicting outcomes 2. Combination has a correlation  NEW modified score prognostic

19. CONCLUTION Used for early detection of unfavourable outcomes RTS  10 dan CT Scan Marshall  2 An easy-to-use modified trauma score on triage setting (accurate, simple, applicable and reliable )

20. ` THANK YOU