INITIAL CRANIAL CT SCAN FOR THE ASSESSMENT OF PROGNOSIS IN HEAD-INJURY

A total of 208 multiple trauma patients with head injury (HI) were inv estigated who had been treated in the period from 1990 to 1995. The av erage age was 35.2 +/- 17.7 years; the injury severity according to IS S was 30.2 +/- 8.6 points; 20.5 % died as a result of the HI; the mort ality of all patients was 26.5 %. The Glasgow Coma Scale (GCS) was det ermined at an average of 22 min after trauma (8.0 +/- 4.3 points) at t he scene of accident. The patients were classified according to GCS in to minor HI (group 1: 14-15 points), moderate HI (group 2: 9-13 points ) and severe HI (group 3: 3-8 points). Patient outcome was assessed by the Glasgow Outcome Scale (GOS) and was classified as good (GOS 4 and 5) and poor (GOS 1, 2 and 3) outcome. At the latest, 2 h after trauma , a CT scan of the head (CCT) was done. The HI groups are compared reg arding frequency of types of injury. In all HI groups the fractures of the bony face occurred at the same frequency (36.0-38.9 %). The frequ ency of calotte fractures (Kal-Fx) increased from group 1 (8.0 %) to 2 (19.2 %) and 3 (25.6 %); fractures of the skull base significantly di ffered between group 1 (16.0 %), 2 (7.8 %) and 3 (33.4 % ). Epidural h emorrhage (EDB) appeared only in group 2 (7.8 %) and 3 (6.7); subdural hemorrhage was found in group 1 (2.7 %), 2 (7.8 %) and 3 (10.0 %). Su barachnoid hemorrhage (SAB) was significantly more frequently seen, de pendent on HI severity, in group 3 (26.7 %) compared to group 2 (11.7 %) and 1 [8.0 %). Intracerebral contusion (ICK) significantly increase d from group 1 (12.0 %) to 2 (27.3) and 3 (45.6 %). Brain swelling (BS ) also significantly increased from group 1 (8.0 %) to 2 (19.5 %) and 3 (49.0 %) and lesions of ventricles (VL) from group 1 (2.7 %) to 2 (1 1.7 %) and 3 (20.0 %). Midline shift (13.4 %) and signs of herniation (4.5 %) only occurred in group 3. The analysis of correlation/regressi on and receiver operating characteristics was able to predict 79 % of patients' outcome accurately using GCS (r 0.54; P < 0.0001) alone, usi ng CCT (r 0.65; P < 0.0001) 87 % were correctly predicted with signifi cant variables Cal-Fx, EDB, SAB and BS. CCT with GCS (r 0.74; P < 0.00 01) were able to predict 88 % accurately with significant variables Ca l-Fx, EDB, BS and GCS. The combination of CCT with GCS, age and ISS (r 0.78; P < 0.0001) was able to predict only 87 % correctly, although t he r value was the highest; significant variables were Kal-Fx, EDB, BS , VL, GCS, age and ISS.