Marshall Score in Traumatic Brain Injury

A scoring system for severity of traumatic brain injury, based on admission noncontrast head CT scan.

Diffuse injury I – there is no visible intracranial pathology seen on CT scan

Diffuse injury II – Cisterns are present with midline shift of 0-5 mm and/or lesions densities present; no high or mixed density lesion >25 cm3 may include bone fragments and foreign bodies

Diffuse injury III (swelling) – Cisterns compressed or absent with midline shift of 0-5 mm; no high or mixed density lesion >25 cm3

Diffuse injury IV (shift) – Midline shift >5 mm; no high or mixed density lesion >25 cm3

V Evacuated mass lesion – Any lesion surgically evacuated

VI High or mixed-density lesion not surgically evacuated – High or mixed density lesion >25 cm3; not surgically evacuated

marshall score

Reference:  Maas AIR, Hukkelhoven CWPM, 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 Dec.;57(6):1173-82

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