Sequential computerized tomography changes and related final outcome in severe head injury patients

Abstract

The authors analysed the serial computerized tomography (CT) findings in a large series of severely head injured patients in order to assess the variability in gross intracranial pathology through the acute posttraumatic period and determine the most common patterns of CT change. A second aim was to compare the prognostic significance of the different CT diagnostic categories used in the study (Traumatic Coma Data Bank CT pathological classification) when gleaned either from the initial (postadmission) or the control CT scans, and determine the extent to which having a second CT scan provides more prognostic information than only one scan. 92 patients (13.3% of the total population) died soon after injury. Of the 587 who survived long enough to have at least one control CT scan 23.6% developed new diffuse brain swelling, and 20.9% new focal mass lesions most of which had to be evacuated. The relative risk for requiring a delayed operation as related to the diagnostic category established by using the initial CT scans was by decreasing order: diffuse injury IV (30.7%), diffuse injury III (30.5%), non evacuated mass (20%), evacuated mass (20.2%), diffuse injury II (12.1%), and diffuse injury I (8.6%). Overall, 51.2% of the patients developed significant CT changes (for worse or better) occurring either spontaneously or following surgery, and their final outcomes were more closely related to the control than to the initial CT diagnoses. In fact, the final outcome was more accurately predicted by using the control CT scans (81.2% of the cases) than by using the initial CT scans (71.5% of the cases only). Since the majority of relevant CT changes developed within 48 hours after injury a pathological categorization made by using an early control CT scan seems to be most useful for prognostic purposes. Prognosis associated with the CT pathological categories used in the study was similar independently of the moment of the acute posttraumatic period at which diagnoses were made.

Hemostatic and neuroprotective effects of human recombinant activated factor VII therapy after traumatic brain injury in pigs

“…Contusion expansion is well documented in both spontaneous and traumatic ICH (Servadei et al, 1995;Oertel et al, 2002;Chang et al, 2006;Chieregato et al, 2005;Lobato et al, 1991;Brott et al, 1997;Fujii et al, 1994;Lobato et al, 1997). A worse clinical outcome following spontaneous ICH is directly associated with the hematoma volume (Mayer et al, 2005a,b;Brott et al, 1997).…”

Which CT features help predict outcome after head injury?

“…Of these, four publications (of n>100) described a novel CT feature recognition or classification [5][6][7][8] and two described further details of the TCDB classification (table 4). 9 10 There were nine other publications but they either had sample size less than 100, 3 14-16 or made no reference to long term outcome, 17 or were concerned with only one feature of trauma, 2 or considered only patients with very mild head injury, 18 or was a duplicate publication, 19 or had mixed clinical and CT variables in one classification, 1 and were therefore excluded. The four studies included had a mean sample size of 418, none stated whether the CT readers were blind to the clinical data, only two used multivariate analyses to correct for association between CT appearance and clinical baseline variables (to test the independent predictive value of CT), and none of the individual classifications described have been validated in a relevant, independent data set.…”

Validation of a prognostic score for early mortality in severe head injury cases

“…In those patients in whom a second CT scan was obtained during this time period (50 patients in the derivation set, 5.4%), the category with the worst prognosis (worst CT) was included in the analyses because it was more strongly correlated with outcome. 20 Maas et al obtained better discrimination using the individual CT characteristics. 23 We also demonstrated a prognostic value for moderate to severe deposits of blood in SAH, but the status of the basal cisterns was more important, as expected in a population of patients with a severe TBI.…”