Chang et al reported the MYSTIC score for evaluating a patient with significant traumatic brain injury (TBI). This can help to predict mortality without early withdrawal of life-sustaining treatments. The authors are from the University of Massachusetts.
Patient selection: moderate to severe traumatic brain injury (TBI)
Parameters:
(1) age in years
(2) pupils
(3) Marshall CT score
(4) motor score for Glasgow coma scale (GCS)
(5) hypotension
(6) hypoxia
(7) subarachnoid hemorrhage on first head CT
(8) epidural hematoma on first head CT
(9) sepsis
(10) SIRS
(11) urinary tract infection
(12) acute renal failure
(13) cardiac arrest
(14) brain edema
(15) cerebellar herniation
|
Parameter |
Finding |
Points |
|
age |
< 60 years |
0 |
|
|
60 to 79 years |
1 |
|
|
>= 80 years |
21 |
|
pupil reactivity |
both |
0 |
|
|
one |
1 |
|
|
none |
14 |
|
Marshall CT score |
2 |
0 |
|
|
3 |
1 |
|
|
4 to 6 |
3 |
|
motor score GCS |
6 |
0 |
|
|
4 or 5 |
1 |
|
|
2 or 3 |
17 |
|
|
1 |
4 |
|
hypotension |
no |
0 |
|
|
yes |
4 |
|
hypoxia |
no |
0 |
|
|
yes |
10 |
|
subarachnoid hemorrhage |
no |
0 |
|
|
yes |
1 |
|
epidural hematoma |
no |
13 |
|
|
yes |
0 |
|
sepsis |
no |
12 |
|
|
yes |
0 |
|
SIRS |
no |
0 |
|
|
yes |
10 |
|
UTI |
no |
14 |
|
|
yes |
0 |
|
acute renal failure |
no |
0 |
|
|
yes |
17 |
|
cardiac arrest |
no |
0 |
|
|
yes |
22 |
|
brain edema |
no |
0 |
|
|
yes |
9 |
|
cerebellar herniation |
no |
0 |
|
|
yes |
13 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score:180
• The higher the score the greater the risk of death.
|
Total Score |
Mortality |
|
0 to 42 |
1-2% |
|
43 to 53 |
8-9% |
|
54 to 64 |
21% |
|
65 to 81 |
60% |
|
>= 82 |
90% |
Performance:
• The area under the ROC curve was 0.94.
Specialty: Surgery, orthopedic, Emergency Medicine
