Marshall classification of traumatic brain injury

The Marshall classification of traumatic brain injury is a CT scan derived metric using only a few features and has been shown to predict outcome in patients with traumatic brain injury.

This system was first published in 1992 building on findings from a large cohort of head injury cases described in 1990 , and at the time of writing (June 2016) remains one of the most commonly used systems for grading acute traumatic brain injury on the basis of CT findings. The Rotterdam score is a more recent system, which attempts to address some of the recognized limitations of the Marshall system, such as struggling to classify patients who have injuries of multiple types . It has been suggested that although both systems are valuable in predicting an outcome, as the newer Rotterdam score incorporates additional variable (e.g. subarachnoid hemorrhage) it may be a preferable measure . It may be that over the coming years the Marshall system will progressively fall out of favor.

Structure

The Marshal system places patients into one of six categories (I to VI) of increasing severity on the basis of findings on non-contrast CT scan of the brain. Higher categories have worse prognosis and survival. It is primarily concerned with two features:

Classification

• diffuse injury I  (no visible pathology)
  • no visible intracranial pathology
• diffuse injury II
  • midline shift of 0 to 5 mm
  • basal cisterns remain visible
  • no high or mixed density lesions >25 cm
• diffuse injury III (swelling)
  • midline shift of 0 to 5 mm
  • basal cisterns compressed or completely effaced
  • no high or mixed density lesions >25 cm
• diffuse injury IV (shift)
  • midline shift >5 mm
  • no high or mixed density lesions >25 cm
• evacuated mass lesion V
  • any lesion evacuated surgically
• non-evacuated mass lesion VI
  • high or mixed density lesions >25 cm
  • not surgically evacuated