ABSTRACT
To determine the prognostic significance of computed tomographic (CT) findings in head injury, retrospective analysis was performed in 128 randomly selected severe head-injury patients managed with a standardized protocol. The minimal criterion for entry into this study was that the patients were unable to obey simple commands or utter formed words. Serial CT was performed on admission and 3-5 days, 2 weeks, 3 months, and 1 year after injury. A scale of severity of abnormalities was devised taking into account the size of the traumatic lesions on CT. The CT findings using the proposed scale were correlated with the clinical outcome and analyzed using linear logistic regression. Other characteristics such as midline shift, multiplicity, and corpus callosum and brainstem lesions were not included in the analysis either because they did not affect the prognosis or because too few of these lesions were present for statistical analysis. The correct prediction rate of outcome using the proposed scale for CT findings alone was found to be 69.7%. When CT findings were combined with the Glasgow Coma Scale score this rate was increased to 75.8%.
Subject(s)
Craniocerebral Trauma/diagnostic imaging , Tomography, X-Ray Computed , Cerebral Hemorrhage/diagnostic imaging , Coma/diagnosis , Craniocerebral Trauma/classification , Humans , Probability , Prognosis , Retrospective StudiesABSTRACT
The authors correlated the computed tomographic (CT) findings and intracranial pressure (ICP) in 150 consecutive comatose head injury patients to determine if noninvasive CT can help identify the patients not requiring ICP monitoring. The study reveals that a majority of patients (55%) with hemorrhagic lesions shown by CT suffer from intracranial hypertension and require ICP monitoring for proper management. Of the patients with normal initial CT, 98% had normal ICP during the first 24 hr. Of the patients with normal CT, 15% developed intracranial hypertension later, irrespective of the initial Glasgow coma scale score or age. More than half of the patients who developed intracranial hypertension subsequently had normal ICP through the first 48 hr. The study indicates that ICP monitoring need not routinely be performed on admission on severe head injury patients with a normal CT. However, repeat CT at 24--48 hr before ICP monitoring in patients with initially normal CT may be valuable, particularly if their clinical status deteriorates.
Subject(s)
Brain Injuries/diagnostic imaging , Intracranial Pressure , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Brain Injuries/complications , Brain Injuries/physiopathology , Cerebral Hemorrhage/diagnostic imaging , Cerebral Hemorrhage/etiology , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , Middle Aged , Monitoring, Physiologic , Prospective StudiesABSTRACT
The evaluation of delayed sequelae of head injury is greatly facilitated by CT. This non-invasive technique provides us with the opportunity to evaluate the head trauma patients sequentially to detect the development and clinical significance of post-traumatic sequelae like delayed intracerebral hemorrhage, hydrocephalus, and post-traumatic atrophy.
