{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T02:17:52Z","timestamp":1790907472314,"version":"4.1.0"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Severe traumatic brain injury (TBI) is associated with intracranial hypertension (ICHTN). The Rotterdam CT score (RS) can predict clinical outcomes following TBI, but the relationship between the RS and ICHTN is unknown. The purpose of this study was to investigate clinical and radiological factors that predict ICHTN in patients with severe TBI.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors performed a single-center retrospective review of patients who, between 2018 and 2021, had an intracranial pressure (ICP) monitor placed following TBI. Radiological and clinical characteristics related to the TBI and ICP monitoring were collected. The main outcome of interest was ICHTN, which was a dichotomous outcome (yes or no) defined on a per-patient basis as an ICP &gt; 22 mm Hg that persisted for at least 5 minutes and required an escalation of treatment. ICHTN included both elevated opening pressure on initial monitor placement and ICP elevations later during hospitalization. Multivariate logistic regression was performed to determine variables associated with ICHTN. Diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve (AUROC).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Seventy patients with severe TBI and an ICP monitor were included in this study. There was a predominance of male patients (94.0%), and the mean patient age was 40 years old. Most patients (67%) had an intraparenchymal catheter placed, whereas 33% of patients had a ventriculostomy catheter placed. In the multivariate logistic regression analysis, the RS was an independent predictor of ICHTN (OR 2.0, 95% CI 1.2\u20133.5, p = 0.014). No instances of ICHTN were observed in patients with an RS of 2 or less and no sulcal effacement. The AUROC of the RS and sulcal effacement was higher than the AUROC of the RS alone for predicting ICHTN (0.76 vs 0.71, p = 0.003, z-test).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The RS was predictive of ICHTN in patients with severe TBI, and the diagnostic accuracy of the model was improved with the inclusion of sulcal effacement at the vertex on CT of the head. Patients with a low RS and no sulcal effacement are likely at low risk for the development of ICHTN.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.6.jns212921","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T19:50:28Z","timestamp":1661370628000},"page":"1050-1057","source":"Crossref","is-referenced-by-count":9,"title":["Novel application of the Rotterdam CT score in the prediction of intracranial hypertension following severe traumatic brain injury"],"prefix":"10.3171","volume":"138","author":[{"given":"Ahmed Ismail","family":"Kashkoush","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamia","family":"Potter","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan C.","family":"Petitt","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Song","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Hunter","sequence":"additional","affiliation":[{"name":"Department of Radiology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"J Neurosurg","first-page":"491","article-title":"The outcome from severe head injury with early diagnosis and intensive management","volume":"47","author":"Becker DP","year":"1977","unstructured":"Becker DP, Miller JD, Ward JD, Greenberg RP, Young HF, Sakalas R. The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg. 1977;47(4):491\u2013502.903803"},{"issue":"6","key":"b2","series-title":"J Neurosurg","first-page":"581","article-title":"Continuous recording of the ventricular-fluid pressure in patients with severe acute traumatic brain injury. A preliminary report","volume":"22","author":"Lundberg N","year":"1965","unstructured":"Lundberg N, Troupp H, Lorin H. Continuous recording of the ventricular-fluid pressure in patients with severe acute traumatic brain injury. A preliminary report. J Neurosurg. 1965;22(6):581\u2013590.5832775"},{"issue":"6","key":"b3","series-title":"J Neurosurg","first-page":"751","article-title":"Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure","volume":"54","author":"Narayan RK","year":"1981","unstructured":"Narayan RK, Greenberg RP, Miller JD,  Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure. J Neurosurg. 1981;54(6):751\u2013762.7241184"},{"issue":"suppl 1","key":"b4","series-title":"J Neurotrauma","first-page":"S1","article-title":"Guidelines for the management of severe traumatic brain injury","volume":"24","year":"2007","unstructured":"Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24(suppl 1):S1\u2013S106"},{"issue":"6","key":"b5","series-title":"Neurosurgery","first-page":"1173","article-title":"Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors","volume":"57","author":"Maas AI","year":"2005","unstructured":"Maas AI, Hukkelhoven CW, Marshall LF, Steyerberg EW. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery. 2005;57(6):1173\u20131182.16331165"},{"issue":"2","key":"b6","series-title":"Psychol Bull","first-page":"322","article-title":"Integration and generalization of kappas for multiple raters","volume":"88","author":"Conger AJ","year":"1980","unstructured":"Conger AJ. Integration and generalization of kappas for multiple raters. Psychol Bull. 1980;88(2):322\u2013328."},{"key":"b7","article-title":"Practical Statistics for Medical Research","author":"Altman DG","year":"1991","unstructured":"Altman DG. Practical Statistics for Medical Research. Chapman & Hall;1991."},{"issue":"5","key":"b8","series-title":"J Neurosurg","first-page":"688","article-title":"Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank","volume":"73","author":"Eisenberg HM","year":"1990","unstructured":"Eisenberg HM, Gary HE Jr, Aldrich EF,  Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg. 1990;73(5):688\u2013698.2213158"},{"issue":"6","key":"b9","series-title":"J Neurosurg","first-page":"784","article-title":"Normal computerized tomography scans in severe head injury. Prognostic and clinical management implications","volume":"65","author":"Lobato RD","year":"1986","unstructured":"Lobato RD, Sarabia R, Rivas JJ,  Normal computerized tomography scans in severe head injury. Prognostic and clinical management implications. J Neurosurg. 1986;65(6):784\u2013789.3772476"},{"issue":"5","key":"b10","series-title":"J Trauma","first-page":"967","article-title":"Initial head computed tomographic scan characteristics have a linear relationship with initial intracranial pressure after trauma","volume":"56","author":"Miller MT","year":"2004","unstructured":"Miller MT, Pasquale M, Kurek S,  Initial head computed tomographic scan characteristics have a linear relationship with initial intracranial pressure after trauma. J Trauma. 2004;56(5):967\u2013973.15179234"},{"issue":"5","key":"b11","series-title":"J Neurosurg","first-page":"650","article-title":"Intracranial pressure: to monitor or not to monitor? 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J Trauma Acute Care Surg. 2021;91(1):114\u2013120.33605705"},{"issue":"1","key":"b13","series-title":"Neurosurgery","first-page":"6","article-title":"Guidelines for the management of severe traumatic brain injury,","volume":"80","author":"Carney N","year":"2017","unstructured":"Carney N, Totten AM, O\u2019Reilly C,  Guidelines for the management of severe traumatic brain injury,. fourth edition. Neurosurgery. 2017;80(1):6\u201315.27654000"},{"issue":"1","key":"b14","series-title":"J Neuroimaging","first-page":"199","article-title":"Early head computed tomography abnormalities associated with elevated intracranial pressure in severe traumatic brain injury","volume":"31","author":"Murray NM","year":"2021","unstructured":"Murray NM, Wolman DN, Mlynash M,  Early head computed tomography abnormalities associated with elevated intracranial pressure in severe traumatic brain injury. J Neuroimaging. 2021;31(1):199\u2013208.33146933"},{"issue":"2","key":"b15","series-title":"J Neurosurg","first-page":"612","article-title":"A clinical decision rule to predict intracranial hypertension in severe traumatic brain injury","volume":"131","author":"Alali AS","year":"2018","unstructured":"Alali AS, Temkin N, Barber J,  A clinical decision rule to predict intracranial hypertension in severe traumatic brain injury. J Neurosurg. 2018;131(2):612\u2013619.30265194"},{"issue":"11","key":"b16","series-title":"J Clin Med","first-page":"2524","article-title":"Evaluation of intracranial hypertension in traumatic brain injury patient: a noninvasive approach based on cranial computed tomography features","volume":"10","author":"Shan Y","year":"2021","unstructured":"Shan Y, Li Y, Xu X, Feng J, Wu X, Gao G. Evaluation of intracranial hypertension in traumatic brain injury patient: a noninvasive approach based on cranial computed tomography features. J Clin Med. 2021;10(11):2524."},{"key":"b17","series-title":"Ther Adv Neurol Disord","first-page":"17562864211069744","article-title":"Ultrasonographic optic nerve sheath diameter as a noninvasive marker for intracranial hypotension","volume":"15","author":"Wang LJ","year":"2022","unstructured":"Wang LJ, Zhang Y, Li C,  Ultrasonographic optic nerve sheath diameter as a noninvasive marker for intracranial hypotension. Ther Adv Neurol Disord. 2022;15:17562864211069744.35186123"},{"issue":"1","key":"b18","series-title":"Ann Transl Med","first-page":"20","article-title":"Ultrasonographic optic nerve sheath diameter monitoring of elevated intracranial pressure: two case reports","volume":"8","author":"Wang LJ","year":"2020","unstructured":"Wang LJ, Chen HX, Tong L, Chen LM, Dong YN, Xing YQ. Ultrasonographic optic nerve sheath diameter monitoring of elevated intracranial pressure: two case reports. Ann Transl Med. 2020;8(1):20.32055611"},{"issue":"2","key":"b19","series-title":"J Neurosurg","first-page":"514","article-title":"Ultrasonographic optic nerve sheath diameter correlation with ICP and accuracy as a tool for noninvasive surrogate ICP measurement in patients with decompressive craniotomy","volume":"133","author":"Wang J","year":"2020","unstructured":"Wang J, Li K, Li H,  Ultrasonographic optic nerve sheath diameter correlation with ICP and accuracy as a tool for noninvasive surrogate ICP measurement in patients with decompressive craniotomy. J Neurosurg. 2020;133(2):514\u2013520."},{"issue":"7","key":"b20","series-title":"Childs Nerv Syst","first-page":"1453","article-title":"Predictors of intracranial hypertension in children undergoing ICP monitoring after severe traumatic brain injury","volume":"36","author":"Miles DK","year":"2020","unstructured":"Miles DK, Ponisio MR, Colvin R,  Predictors of intracranial hypertension in children undergoing ICP monitoring after severe traumatic brain injury. Childs Nerv Syst. 2020;36(7):1453\u20131460.31970473"},{"issue":"3","key":"b21","series-title":"Eur J Transl Myol","first-page":"7542","article-title":"Marshall and Rotterdam Computed Tomography scores in predicting early deaths after brain trauma","volume":"28","author":"Mohammadifard M","year":"2018","unstructured":"Mohammadifard M, Ghaemi K, Hanif H, Sharifzadeh G, Haghparast M. Marshall and Rotterdam Computed Tomography scores in predicting early deaths after brain trauma. Eur J Transl Myol. 2018;28(3):7542.30344974"},{"issue":"2","key":"b22","series-title":"Br J Neurosurg","first-page":"258","article-title":"Predicting outcomes of decompressive craniectomy: use of Rotterdam Computed Tomography Classification and Marshall Classification","volume":"30","author":"Waqas M","year":"2016","unstructured":"Waqas M, Shamim MS, Enam SF,  Predicting outcomes of decompressive craniectomy: use of Rotterdam Computed Tomography Classification and Marshall Classification. Br J Neurosurg. 2016;30(2):258\u2013263.26828246"},{"issue":"6","key":"b23","series-title":"Acta Neurochir (Wien)","first-page":"1069","article-title":"Dynamics of brain tissue changes induced by traumatic brain injury assessed with the Marshall, Morris-Marshall, and the Rotterdam classifications and its impact on outcome in a prostacyclin placebo-controlled study","volume":"154","author":"Bobinski L","year":"2012","unstructured":"Bobinski L, Olivecrona M, Koskinen LO. Dynamics of brain tissue changes induced by traumatic brain injury assessed with the Marshall, Morris-Marshall, and the Rotterdam classifications and its impact on outcome in a prostacyclin placebo-controlled study. Acta Neurochir (Wien). 2012;154(6):1069\u20131079."},{"key":"b24","series-title":"J Surg Res","first-page":"385","article-title":"The whole is greater than the sum of its parts: GCS versus GCS-motor for triage in geriatric trauma","volume":"261","author":"Deeb AP","year":"2021","unstructured":"Deeb AP, Phelos HM, Peitzman AB, Billiar TR, Sperry JL, Brown JB. The whole is greater than the sum of its parts: GCS versus GCS-motor for triage in geriatric trauma. J Surg Res. 2021;261:385\u2013393."},{"key":"b25","series-title":"World Neurosurg","first-page":"e179","article-title":"Predictors of mortality, withdrawal of life-sustaining measures, and discharge disposition in octogenarians with subdural hematomas","volume":"157","author":"Kashkoush A","year":"2022","unstructured":"Kashkoush A, Petitt JC, Ladhani H, Ho VP, Kelly ML. Predictors of mortality, withdrawal of life-sustaining measures, and discharge disposition in octogenarians with subdural hematomas. 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