A new classification of head injury based on computerized tomography

Abstract

A new classification of head injury based primarily on information gleaned from the initial computerized tomography (CT) scan is described. It utilizes the status of the mesencephalic cisterns, the degree of midline shift in millimeters, and the presence or absence of one or more surgical masses. The term "diffuse head injury" is divided into four subgroups, defined as follows: Diffuse Injury I includes all diffuse head injuries where there is no visible pathology; Diffuse Injury II includes all diffuse injuries in which the cisterns are present, the midline shift is less than 5 mm, and/or there is no high-or mixed-density lesion of more than 25 cc; Diffuse Injury III includes diffuse injuries with swelling where the cisterns are compressed or absent and the midline shift is 0 to 5 mm with no high-or mixed-density lesion of more than 25 cc; and Diffuse Injury IV includes diffuse injuries with a midline shift of more than 5 mm and with no high-or mixed-density lesion of more than 25 cc. There is a direct relationship between these four diagnostic categories and the mortality rate. Patients suffering diffuse injury with no visible pathology (Diffuse Injury I) have the lowest mortality rate (10%), while the mortality rate in patients suffering diffuse injury with a midline shift (Diffuse Injury IV) is greater than 50%. When used in conjunction with the traditional division of intracranial hemorrhages (extradural, subdural, or intracerebral), this categorization allows a much better assessment of the risk of intracranial hypertension and of a fatal or nonfatal outcome. This more accurate categorization of diffuse head injury, based primarily on the result of the initial CT scan, permits specific subsets of patients to be targeted for specific types of therapy. Patients who would appear to be at low risk based on a clinical examination, but who are known from the CT scan diagnosis to be at high risk, can now be identified. KEY WOROSTraumatic Coma Data Bank 9 head injury 9 coma 9 intracranial pressure 9 computerized tomography 9 grading system N 'EUROSURGEONS and others interested in treating head-injured patients have traditionally categorized head injury on the basis of focal or nonfocal lesions or, more recently, on the basis of diffuse versus focal or mass lesions. ~' 2 These categorizations, while helpful in subdividing head injury into two major groups, have significant limitations in terms of prognosis. It is generally recognized that patients with diffuse injury have a lower mortality rate than do patients with mass lesions. However, this type of pooling of patient data might mask groups of patients with diffuse injury who are at risk from intracranial hypertension and who in fact have a high mortality rate.A general lack of recognition of the importance of $14 J. Neurosurg. / Volume 75/

Computed tomography and magnetic resonance imaging in mild to moderate head injury: Early and late imaging related to outcome

“…Patients with a history of previous hospitalization for HI, addiction to alcohol or drugs, known psychiatric disorder, or mental retardation were excluded. Forty-three patients sustained a mild HI (GCS on admission of [13][14] and 24 patients sustained a moderate HI (GCS on admission of 9 -12).…”

“…In severe HI, outcome is affected by the type of intracranial lesion demonstrated by CT on admission. [11][12][13] Less is known, however, about the prognostic value of CT for outcome in mild to moderate HI. In approximately 10 to 40% of patients in this category, abnormalities are reported.…”

Prognostic value of various intracranial pathologies in traumatic brain injury

“…In the same way, AIS codes were differentiated according to the Marshall Classification [16]. An algorithm was applied which enabled a Marshall class to be allocated to each patient when the patient's AIS codes are at hand [21].…”

“…This is presented as 140652. 4 Furthermore, the Marshall Classification of CT findings in TBI was first introduced in 1991 and is used to have a more accurate predictive assessment of TBI patients who sustained intracranial hypertension by considering those injuries which are causes of or somehow related to raised intracranial pressure [16]. Since this classification is based on the degree of brain swelling or the extent of mass lesion, it disregards physiological characteristics and the anatomical distribution of injuries in that, for example, contusion, SDH or EDH are all considered as mass lesions.…”

Prevention of Secondary Insults in Neurointensive Care of Traumatic Brain Injury

“…73 patients achieved GCS M 6, 56 GCS M 5 and 25 GCS M 1-4. Severity was also characterized according to the Traumatic Coma Data Bank classification [26] of the first CT scan performed in each patient. 70 patients had diffuse injury II, 36 diffuse injury III, and six diffuse injury IV, and 42 patients had mass lesions.…”