IMPACT OF TRAUMATIC SUBARACHNOID HEMORRHAGE ON OUTCOME IN NONPENETRATING HEAD-INJURY .1. A PROPOSED COMPUTERIZED-TOMOGRAPHY GRADING SCALE
IMPACT OF TRAUMATIC SUBARACHNOID HEMORRHAGE ON OUTCOME IN NONPENETRATING HEAD-INJURY .1. A PROPOSED COMPUTERIZED-TOMOGRAPHY GRADING SCALE
复制标题
DOI：
10.3171/jns.1995.83.3.0445
复制
发表时间：
1995-09-01
影响因子：
4.1
通讯作者：
HARRINGTON, TR
中科院分区：
文献类型：
--
作者：
GREENE, KA;MARCIANO, FF;HARRINGTON, TR
经证明，对患有严重非穿透性头部损伤的患者进行入院计算机断层扫描 (CT) 扫描时发现，外伤性蛛网膜下腔出血 (tSAH) 的结果比单纯损伤更糟糕。然而，之前的研究还没有提供一种简单的方法，将 tSAH 的数量、其位置或初始头部 CT 扫描的其他异常结果与非穿透性头部损伤患者的结果联系起来。在这项研究中，对在同一机构接受治疗的 252 名 tSAH 患者的入院头部 CT 扫描进行了审查，以确定 tSAH 的厚度；它的位置；肿块病变的证据；中线结构移位（小于或等于 5 毫米 vs. > 5 毫米）；基底池消失；和皮质沟消失。然后将 CT 扫描分为 1 至 4 级，其中 1 级表示 tSAH 较薄（小于或等于 5 mm）； 2、厚tSAH（>5毫米）； 3、薄型 tSAH，伴肿块病变； 4，厚的 tSAH 并伴有肿块病变。 CT 特征的逐步回归分析按照对急性住院出院时格拉斯哥结果量表 (GOS) 评分的贡献降序排列如下：基底池消失、tSAH 厚度、皮质沟消失、肿块病变的存在和 tSAH 的位置。中线结构的转变并未被发现是一个显着的变量。比较 CT 分级和入院复苏后格拉斯哥昏迷量表 (GCS) 评分的进一步分析非常显着。 CT分级较低的患者比CT分级较高的患者有更好的入院GCS值和出院GOS评分。根据他们的经验：作者得出的结论是，他们的 CT 分级量表简单可靠，与急性住院出院时的结果显着相关。
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 nonpenetrating 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 (less than or equal to 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 (less than or equal to 5 mm); 2, thick tSAH (> 5 mm); 3, thin tSAH with mass a 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.