For healthcare professionals
Helsinki CT Score
The Helsinki CT score grades the head CT after traumatic brain injury with points for the type of mass lesion, a hematoma volume over 25 cm3, intraventricular hemorrhage and the state of the basal cisterns. This tool is written for clinicians. It is not a self-check and not a diagnosis.
The CT findings
Items and points as printed by Thelin and colleagues (Thelin 2017). More than one mass lesion type can be present. Nothing you enter leaves this page.
What you will see
The Helsinki CT score, from −3 to 14, and the points behind it.
Educational only, not medical advice. A score supports clinical judgment; it does not decide treatment on its own.
Source
Raj R et al., Neurosurgery 2014 (the original score, cited only). Items and points as printed in Thelin EP et al., PLoS Med 2017 (CC BY), Table 1.
Validated in
Patients with traumatic brain injury and a head CT. Raj 2014 built the score in 869 patients treated in neuro-intensive care at Helsinki University Hospital from 2009 to 2012 (as described by Thelin 2017). Thelin 2017 validated it in 1,115 patients in neuro-intensive care in Stockholm and Helsinki.
Limits
For clinicians, not a diagnosis. Some items need judgment: examiners sometimes found it hard to tell whether an intracerebral hematoma or contusion lay in the brain or in the subarachnoid space, and the 25 cm3 volume is an estimate (Thelin 2017). Both validation cohorts in Thelin 2017 were patients in neuro-intensive care. Use it with, not instead of, clinical judgment.
The items and points
Raj and colleagues described the score in 2014 (Raj 2014). The items and points below are as printed by Thelin and colleagues (Thelin 2017).
| Item | Points |
|---|---|
| Mass lesion type, if present | Subdural hematoma: 2, intracerebral hematoma: 2, epidural hematoma: −3 |
| Mass lesion size | Hematoma volume > 25 cm3: 2 |
| IVH | Present: 3 |
| Basal cisterns | Normal: 0, compressed: 1, absent: 5 |
| Score | Sum (range: −3 to 14) |
As printed in Thelin 2017, Table 1 (Thelin 2017). The printed range of −3 to 14 only works if each mass lesion type present is counted, so this tool adds them up. Thelin notes that the Helsinki score is built from parts of the Marshall classification and the Rotterdam score but looks more closely at the type of intracranial injury (Thelin 2017).
For example, a scan with a subdural hematoma over 25 cm3, compressed basal cisterns and no intraventricular blood scores 2 + 2 + 1 = 5.
What studies found
In 1,115 patients from Stockholm and Helsinki, the median Helsinki CT score was 5 (interquartile range 3 to 7) (Thelin 2017). For unfavorable outcome (Glasgow Outcome Scale 1 to 3) the area under the curve (AUC) in the combined cohort was 0.72 (95% CI 0.69 to 0.75), and for death against survival it was 0.74 (0.70 to 0.77) (Thelin 2017). These were higher than for the Rotterdam CT score (0.68 and 0.68) and the Marshall classification (0.58 and 0.61) and lower than for the Stockholm CT score (0.77 and 0.77) (Thelin 2017). Added to a model of age, pupil response, Glasgow Coma Scale, hemoglobin and glucose, the Helsinki score raised Nagelkerke’s pseudo-R2 from 0.38 to 0.42 (p < 0.01) (Thelin 2017).
Other papers describe the Helsinki score differently from Thelin’s Table 1, with other parts and a different range (Rakip 2026). Figures from such a version do not apply to the score worked out here, so this page does not show them.
Limits
Thelin and colleagues found the Helsinki score easier and faster to use than the Stockholm score, but it still involves some judgment: telling compressed from obliterated basal cisterns, and whether a mass lesion is over 25 cm3, since the “ABC/2” method is only an estimate (Thelin 2017). Both validation cohorts in Thelin 2017 were patients in neuro-intensive care (Thelin 2017).
Related tools
For other scores from the same admission CT, see the Rotterdam CT score and the Marshall CT classification. For the bedside level of consciousness, use the Glasgow Coma Scale calculator; to add the pupil response, see the GCS-Pupils score. To grade outcome after a brain injury, see the Glasgow Outcome Scale. Other bedside scores are listed under For healthcare professionals.
Sources
- Raj R, Siironen J, Skrifvars MB, Hernesniemi J, Kivisaari R. Predicting outcome in traumatic brain injury: development of a novel computerized tomography classification system (Helsinki computerized tomography score). Neurosurgery. 2014;75(6):632-647. doi:10.1227/NEU.0000000000000533. Journal and pages confirmed via CrossRef. Original score (cited only). doi.org/10.1227/NEU.0000000000000533
- Thelin EP, Nelson DW, Vehvilainen J, et al. Evaluation of novel computerized tomography scoring systems in human traumatic brain injury: an observational, multicenter study. PLoS Med. 2017;14(8):e1002368. doi:10.1371/journal.pmed.1002368. PMID 28771476. Open access (CC BY 4.0). Table 1 (Rotterdam CT score items, points, sum + 1, range 1 to 6; Helsinki CT score items, points, sum, range −3 to 14); Table 2 (1,115 patients, score distribution); Table 3 (AUCs). The 2023 republication notice (PLoS Med 20(11):e1004320) removed a supporting file only. pmc.ncbi.nlm.nih.gov/articles/PMC5542385/
- Rakip U, Yıldızhan S, Canbek İ, et al. External validation and comparative performance of Marshall, Rotterdam, and Helsinki computed tomography scores in adult traumatic brain injury. BMC Emerg Med. 2026;26:242. doi:10.1186/s12873-026-01655-z. PMID 42332581. Open access (CC BY 4.0). Journal confirmed via CrossRef. Table 2 (types I to VI), Table 3 (in-hospital mortality by type), Table 4 (AUCs). pmc.ncbi.nlm.nih.gov/articles/PMC13548489/
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-04. Spotted an error? See About.