Faculty Collaboration Database

Impact of traumatic subarachnoid hemorrhage on outcome in nonpenetrating head injury. Part I: A proposed computerized tomography grading scale. J Neurosurg 1995 Sep;83(3):445-52

Date

09/01/1995

Pubmed ID

7666221

DOI

10.3171/jns.1995.83.3.0445

Scopus ID

2-s2.0-0029148790 (requires institutional sign-in at Scopus site)   82 Citations

Abstract

The presence of traumatic subarachnoid hemorrhage (tSAH) on admission computerized tomography (CT) scans obtained from patients suffering from severe, nonpenetrating head injury has been shown to be associated with a worse outcome than the injury alone would warrant. However, no previous study has provided a simple means of relating the amount of tSAH, its location, or other abnormal findings on initial head CT scans to outcome in patients with non-penetrating head injury. In this study, admission head CT scans from 252 patients with tSAH, treated at a single institution, were reviewed to ascertain thickness of the tSAH; its location; evidence of mass lesion(s); shift of midline structures (< or = 5 mm vs. > 5 mm); basal cistern effacement; and cortical sulcal effacement. The CT scans were then organized into Grades 1 to 4 with 1 indicating thin tSAH (< or = 5 mm); 2, thick tSAH (> 5 mm); 3, thin tSAH with mass lesion(s); and 4, thick tSAH with mass lesion(s). A stepwise regression analysis of CT features ranked them in descending order of contribution to Glasgow Outcome Scale (GOS) scores at the time of discharge from acute hospitalization as follows: basal cistern effacement, thickness of tSAH, cortical sulcal effacement, presence of mass lesion(s), and location of tSAH. A shift of midline structures was not found to be a significant variable. Further analysis comparing CT grades and admission postresuscitation Glasgow Coma Scale (GCS) scores was highly significant. Patients with lower CT grades had better admission GCS values and discharge GOS scores than those with higher CT grades. From their experience, the authors conclude that their CT grading scale is simple and reliable and relates significantly to outcome at the time of discharge from acute hospitalization.

Author List

Greene KA, Marciano FF, Johnson BA, Jacobowitz R, Spetzler RF, Harrington TR

Author

Karl A. Greene MD Adjunct Assistant Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Craniocerebral Trauma
Databases, Factual
Female
Glasgow Coma Scale
Humans
Infant
Male
Middle Aged
Prognosis
Prospective Studies
Regression Analysis
Retrospective Studies
Subarachnoid Hemorrhage
Tomography, X-Ray Computed
Treatment Outcome
Wounds, Nonpenetrating