CT classification & Prognosis of head injury

Kim,  Gab Teug

J Korean Soc Emerg Med > Volume 8(2); 1997 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 1997;8(2): 264-276.

CT classification & Prognosis of head injury

ABSTRACT

The CT classification of diffuse head injury permits the early identification of patients at high risk from intracranial hypertension and allows the neurosurgeon the option of early intervention. With the CT classification it is feasible to identify the 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. The CT classification was based on the status of the mesencephalic cisterns and the degree of midline shift. Diffuse head injury was divided into four subgroups(I, II, III, IV). We analyzed 276 patients with diffuse head injury from January 1995 to september 1996 for identification of likelihood of early raised intracranial pressure in emergency room and decision about early management in patients with diffuse injury. There was close relationship between these diffuse injury type of CT scan and the prognosis. Patients suffering with no pathology(diffuse injury I) and without compression of mesencephalic cistern and midline shift (diffuse injury II) had the lowest mortality rate(1.3%,4.1%), while the mortality rate in patients suffering diffuse injury with a obliteration of mesencephalic cistern(diffuse injury IIIB) and midline shift(diffuse injury IV) was greater than 50%(84.2%,50.0%). The CT diagnosis was a highly significant independent predictor of mortality in diffuse injury I and IIIB but there was an interdependence between the degree of consciousness level and pupil change and the finding on CT scan in diffuse injury II, IIIA and IV.