Marshall criteria used for ICP bolt insertion decisions in severe TBI.
Brain Image Probe
Categorize head injury severity by analyzing midline shift, cisternal patency, and lesion volume according to the Marshall classification.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Standard classification for diffuse Traumatic Brain Injury (TBI).
Predicting risk of intracranial hypertension and mortality.
Identifying candidates for ICP monitor placement according to BTF (Brain Trauma Foundation) guidelines.
Section 2
Formula & Logic
Definitions
Category
Findings
I
No visible pathology
II
Cisterns open; Shift 0–5 mm; No high/mixed density lesion > 25 cm³
III
Cisterns compressed/absent; Shift 0–5 mm; No high/mixed density lesion > 25 cm³
IV
Midline shift > 5 mm; No high/mixed density lesion > 25 cm³
V
Any evacuated mass lesion
VI
Non-evacuated mass lesion > 25 cm³
Section 3
Pearls/Pitfalls
Basal Cisterns
The presence or absence of the basal cisterns is the most powerful radiologic predictor of mortality in the Marshall system. Absence of cisterns (Grade III) doubles mortality compared to Grade II (34% vs 14%).
Section 4
Evidence Appraisal
Primary Reference
The diagnosis of head injury requires a classification based on computed axial tomography
Marshall LF et al. • J Neurotrauma. 1992;9 Suppl 1:S287-92
