CT of early and late posttraumatic brain lesions in evaluation of the risk of deterioration and prognosis of clinical outcome

The authors analysed Traumatic Coma Data Bank (TCDB) based on the initial posttraumatic brain computerized tomography findings (CT) using the Marshall's classification. It utilizes the status of the mesencephalic cisterns, the degree of medline shift and the presence or absence of one or more surgical masses. This classification allows us to assess the risk of intracranial hypertension. 1. The prognostic value of computerized tomography in patients with head injuries based on TCDB (Marshall) classification. 2. The relationship between the CT findings and the clinical examination. 3. The evaluation of the patients condition one year after trauma. The paper summarized the outcome of 523 patients with head injuries, 383 male (73.23%) and 140 female (26.77%), who underwent the initial CT scan in the first 48 hours after the injury. The age of the patients ranged from 17 to 88 years, the mean age for male was 42.86-18.72 years, and for female 47-19.22 years. The Glasgow Coma Scale was used at admission to hospital. The general condition of patients and the results of therapy were different in each category. 221 patients (42.26%) underwent surgery and 302 (57.74%) were treated medically. The highest mortality and complication rate was observed in categories III, IV and VII. The risk of mortality rate was higher in older group (age >40 years), chi2=0.528; p<0.015. During hospitalisation 98 patients had died, 425 patients showed satisfactory outcome and were discharged from the hospital. A year later, these patients underwent follow-up CT and clinical examinations. The TCDB (Marshall) classification used in conjunction with the Glasgow Coma Scale (GCS), the result of clinical examination, and age, provides more accurate foundation for prognosis of outcome. The TCDB (Marshall) classification of head injury enables early identification of patients who are potentially at high risk of intracranial hypertension and allows the neurosurgeon to consider an option of early intervention. As a consequence, not only can the mortality rate decrease but complication rate due to head injury as well. There is a direct relationship between outcome and the CT scan diagnosis (rho=0.66; p >0.0001). Except for localization and volume of the changes, the outcome of patients with head injuries depends on the cistern condition. The compression of cisterns menaces the secondary brainstem damage. The clinical outcome one year after the injury resembled CT scan findings in all categories. (author)