SEQUENTIAL COMPUTERIZED-TOMOGRAPHY CHANGES AND RELATED FINAL OUTCOME IN SEVERE HEAD-INJURY PATIENTS

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 pos ttraumatic period and determine the most common patterns of CT change. A second aim was to compare the prognostic significance of the differ ent CT diagnostic categories used in the study (Traumatic Coma Data Ba nk CT pathological classification) when gleaned either from the initia l (postadmission) or the control CT scans, and determine the extent to which having a second CT scan provides more prognostic information th an only one scan. 92 patients (13.3% of the total population) died soo n after injury. Of the 587 who survived long enough to have at least o ne 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 relat ive risk for requiring a delayed operation as related to the diagnosti c category established by using the initial CT scans was by decreasing order: diffuse injury IV (30.7%), diffuse injury III (30.5%), non eva cuated 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 spontane ously 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 s cans (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 usi ng an early control CT scan seems to be most useful for prognostic pur poses. Prognosis associated with the CT pathological categories used i n the study was similar independently of the moment of the acute postt raumatic period at which diagnoses were made.