Latar Belakang. Traumatic brain injury (TBI) merupakan penyebab utama mortalitas dan morbiditas di kalangan anak muda di seluruh dunia. TBI diklasifikasikan menjadi cedera kepala ringan, cedera kepala sedang dan cedera kepala berat. Selain GCS, penilaian reaktivitas pupil merupakan prosedur standar evaluasi neurologis. Dilatasi pupil akut pada pasien cedera kepala menunjukkan darurat neurologis. Secara klasik, fenomena ini diduga disebabkan oleh herniasi akibat edema cerebri atau hemorrhagic yang menyebabkan kompresi nervus occulomotorius yang pada gilirannya menyebabkan dilatasi pupil yang sebenarnya. Nilai GCS dan reflex pupil memiliki kemampuan yang baik untuk memperkirakan outcome pasien TBI. Computed Tomography (CT) memiliki peranan penting dalam menilai pasien dengan TBI untuk mendeteksi lesi hemorrhagic pasca trauma. Tujuan penelitian ini adalah untuk mengetahui perbandingan sistem penilaian CT kepala menurut klasifikasi Marshall dan klasifikasi Rotterdam berdasarkan reaktivitas pupil pada pasien TBI. Bahan dan Metode. Bahan penelitian 53 orang pasien TBI yang telah dilakukan pemerikasaan CT kepala di Instalasi radiologi RSUP. Dr. Sardjito, bulan November 2014 sampai Februari 2015 yang memenuhi kriteria inklusi dan eksklusi. CT kepala dibaca oleh Dokter Spesialis Radiologi menggunakan sistem skor Marshall dan skor Rotterdam. Metode penelitian ini observasional dengan rancang bangun analitik assosiatif komparatif kategorik dan pengambilan sampel secara retrospektif. Hasil. Perbandingan antara skor CT Marshall dan skor CT Rotterdam berdasarkan nilai reflex pupil didapatkan hubungan yang signifikan kuat, yaitu p = 0,10 pada skor CT Marshall , p = 0,001 pada skor Rotterdam. Areas Under the receiver operating Characteristic curve (AUCs), interval kepercayaan 95%, menunjukkan bahwa kedua sistem skoring memiliki kemampuan diskriminatif sama baik terhadap reflex pupil (Marshall, AUC = 0, 952 [0, 873 - 1, 031] vs. Skor Rotterdam , AUC = 0.885 [0, 729 - 1, 040]). Kedua nilai secara spensifitas memiliki performa yang sempurna terkait dengan reflex pupil. Kesimpulan. Kenaikan skoring CT kepala berdasarkan klasifikasi Marshall dan klasifikasi Rotterdam diikuti dengan penurunan nilai reflex pupil.

Background. Traumatic brain injury (TBI) is a major cause of mortality and morbidity among young people worldwide. TBI is classified into mild, moderate, and severe head injury. In addition to GCS, pupil reactivity assessment is a standard neurological evaluation procedure. Dilated pupils in acute head injury patients show neurological emergency. Clasically, this phenomenon is thought to be caused by the herniation due to cerebral edema or hemorrhage that causes occulomotor nerve compression. GCS and pupil reflex have good ability to predict the outcome of TBI patients. Computed tomography (CT) is important role in assessing patients with TBI to detect post-traumatic hemorrhage. The aim of this study is comparison of Marshall clasification and Rotterdam classification based on pupil reactivity in TBI using head CT. Material and Method. Study population consisted of 53 patients with TBI, admission in Dr. Sardjito Central General Hospital between November 2014 until February 2015, fulfil inclusion and exclusion criteria. Head CT read by one Radiologist based on Marshall and Rotterdam scoring system. This is a retrospective observational study with associative comparative categorical. Result. There was statistically significant association between Marshall CT score and Rotterdam CT score based on the value of pupil reflex (p=0.010 for Marshall CT score, p=0.001 for Rotterdam score). Areas Under the receiver operating Characteristic curve (AUCs), 95% confidence interval, indicates that both scoring systems have the ability to discriminate equally against pupil reflex (AUC=0,952 [0,873-1,031] for Marshall score vs AUC=0,885 [0,729-1,040] for Rotterdam score). Both systems has good performance associated with pupil reflex. Conclusion. The increment in Marshall CT score and Rotterdam CT score was followed by pupil reflex impairment. Rotterdam scoring system performance was equal if not slightly better than Marshall scoring system, based on pupil reactivity outcome.

Kata Kunci : CT, Marshall scoring, Rotterdam scoring, Traumatic brain injury, pupil reflex