Sequential computerized tomography changes and related final outcome in severe head injury patients
Sequential computerized tomography changes and related final outcome in severe head injury patients
复制标题
DOI：
10.1007/bf01808871
复制
发表时间：
1997-01-01
影响因子：
2.4
通讯作者：
Rivero, B
中科院分区：
文献类型：
--
作者：
Lobato, RD;Gomez, PA;Rivero, B
作者分析了一系列严重头部受伤患者的连续计算机断层扫描 (CT) 结果，以评估急性创伤后时期颅内病理的变异性，并确定 CT 变化的最常见模式。第二个目的是比较研究中使用的不同 CT 诊断类别（创伤性昏迷数据库 CT 病理分类）从初始（入院后）或对照 CT 扫描收集的预后意义，并确定第二次 CT 扫描比仅一次扫描提供更多预后信息的程度。92 名患者（占总人口的 13.3%）在受伤后很快死亡。在 587 名存活时间足以进行至少一次对照 CT 扫描的患者中，23.6% 出现新的弥漫性脑肿胀，20.9% 出现新的局灶性肿块病变，其中大部分必须被清除。与使用初始 CT 扫描建立的诊断类别相关的需要延迟手术的相对风险按降序排列：弥漫性损伤 IV (30.7%)、弥漫性损伤 III (30.5%)、未疏散肿块 (20%)、疏散肿块 (20.2%)、弥漫性损伤 II (12.1%) 和弥漫性损伤 I (8.6%)。 总体而言，51.2% 的患者出现明显的 CT 改变（更严重或更严重）。更好）自发发生或手术后发生，其最终结果与控制的相关性比与初始 CT 诊断的相关性更密切。事实上，使用对照 CT 扫描（占 81.2% 的病例）比使用初始 CT 扫描（仅占 71.5% 的病例）更能准确地预测最终结果。由于大多数相关的 CT 变化是在受伤后 48 小时内发生的，因此通过使用早期对照 CT 扫描进行的病理分类似乎对于预后目的最有用。研究中使用的 CT 病理分类相关的预后相似，与诊断的急性创伤后时期无关。
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 posttraumatic period and determine the most common patterns of CT change. A second aim was to compare the prognostic significance of the different CT diagnostic categories used in the study (Traumatic Coma Data Bank CT pathological classification) when gleaned either from the initial (postadmission) or the control CT scans, and determine the extent to which having a second CT scan provides more prognostic information than only one scan.92 patients (13.3% of the total population) died soon after injury. Of the 587 who survived long enough to have at least one 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 relative risk for requiring a delayed operation as related to the diagnostic category established by using the initial CT scans was by decreasing order: diffuse injury IV (30.7%), diffuse injury III (30.5%), non evacuated 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 spontaneously 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 scans (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 using an early control CT scan seems to be most useful for prognostic purposes.Prognosis associated with the CT pathological categories used in the study was similar independently of the moment of the acute posttraumatic period at which diagnoses were made.