Comparative performance of Rotterdam and Helsinki CT scores for early prognostication in traumatic brain injury

Abstract

Objective: To compare the prognostic performance of the Rotterdam and Helsinki computed tomography (CT) scoring systems for predicting early outcome in traumatic brain injury (TBI).

Methodology: This prospective observational study included consecutive patients with TBI undergoing admission non-contrast head CT at Mardan Medical Complex from February 2025 to July 2025. CT scans were scored using the Rotterdam and Helsinki systems. Outcome was assessed using the Glasgow Outcome Scale (GOS) at hospital discharge. Statistical analysis included univariable and GCS-adjusted binary logistic regression and receiver operating characteristic (ROC) analysis.

Results: A total of 312 patients were included; 27 (8.7%) had a poor discharge outcome (GOS 1–3). Poor outcome was associated with higher Rotterdam and Helsinki CT scores and lower admission GCS (p<0.001). On univariable analysis, Rotterdam (OR 4.56) and Helsinki (OR 1.65) scores were associated with poor outcome. After adjustment for admission GCS, Helsinki remained significantly associated with poor outcome (adjusted OR 1.21, 95% CI 1.02–1.44, p=0.032), whereas Rotterdam did not (adjusted OR 1.72, 95% CI 0.88–3.34, p=0.112). Rotterdam showed AUC 0.915 (95% CI 0.868–0.963) and Helsinki AUC 0.876 (95% CI 0.781–0.970).

Conclusion: Both scores demonstrated useful discrimination for early discharge outcome. Helsinki retained a modest independent association with poor outcome after GCS adjustment, whereas Rotterdam showed higher unadjusted discrimination. Larger cohorts with longer follow-up are needed for validation.