The Value of the “Worst” Computed Tomographic Scan in Clinical Studies of Moderate and Severe Head Injury

Abstract

When an admission CT scan demonstrates evidence of a diffuse injury, follow-up scans should be performed, because approximately one in six such patients will demonstrate significant CT evolution. In studies comparing series of head-injured patients, correspondence of timing of CT scans is necessary for valid comparison.

Prognostic value of various intracranial pathologies in traumatic brain injury

“…In the analysis of the types of haemorrhage, none showed a significant association with the outcome, despite this being observed in other studies [1][2][3][4][5][6][7][8][9][10][11][12][13]. This finding was thought to be perhaps due to the given combination of intracranial pathologies used in Table 1.…”

“…In fact, the analysed dataset is more representative of TBI victims who sustain intracranial pathologies, as 35.8% of cases had, at admission, mild GCS (i.e. [ 13). This subgroup of patients represents those patients who 'talk and die'.…”

“…The Marshall Classification has been proposed as a classifier of CT findings in TBI, whereas AIS coding is based on information obtained from any source (such as operation notes) or diagnostic modality (including CT or magnetic resonance imaging [MRI]). This is also relevant regarding the dynamic changes of intracranial pathologies [13], which can be reflected in the AIS coding but not in the Marshall Classification (the Marshall Classification is performed at a certain cut-off point in time, often at admission). It is, as yet, unclear how the Marshall Classification maintains its prognostic strength if AIS codes are used instead of directly observing the CT image [21].…”

“…There are several traditional terms such as intracranial haemorrhage, subarachnoid haemorrhage (SAH), epidural haemorrhage (EDH), subdural haemorrhage (SDH) or brain swelling to describe the structural brain damage. The association of these pathologies such as intracranial haemorrhage [1], SAH [2][3][4][5][6][7][8][9][10], SDH [7,11,12], EDH [2,[5][6][7]11] and brain swelling [3,11,13] with outcome has been shown in the TBI literature.…”

“…The TARN data offer the opportunity to assess the predictive performance of various intracranial pathologies in TBI. The studies on this issue so far have been conducted on older datasets, which may not take account of temporal advances and improvements in trauma care systems [1][2][3][4][5][6][7][8][9][10][11][12][13]. The objective of this study is twofold: first, to determine the relative prognostic strength of various AIS severity scores of brain injury, the Marshall Classification and various intracranial pathologies, and, second, to determine which intracranial pathologies are more important for outcome prediction in TBI using a more recent dataset.…”