Servadei F, Nasi M T, Giuliani G, Cremonini A M, Cenni P, Zappi D, Taylor G S
Department of Neurosurgery-Neurotraumatology, Ospedale Maurizio Bufalini, Cesena, Italy.
Br J Neurosurg. 2000 Apr;14(2):110-6. doi: 10.1080/02688690050004525.
The relationship between radiological findings and outcome in patients with acute posttraumatic subdural haematomas (SDH) has been based on CT obtained upon hospital admission. This study was undertaken to investigate the effects on prognosis of SDH patients of lesions not present on admission, but detected by subsequent CT. We have also studied those findings present on admission CT that could predict worsening of the associated lesions. From 1 May 1989 to 30 April 1996, we admitted 206 patients harbouring acute SDH of thickness 5 mm or more. The admission GCS score ranged from 3 to 15. Each patient underwent CT on admission (always within 3 h from injury). Follow-up CT was performed within 12-24 h after injury and in the following days (an average of 4.3 examinations for each patient). These examinations were reviewed by a neuroradiologist and the 'worst' CT was determined. We defined the 'worst' examination as that showing the largest haematoma thickness/midline shift and/or with the most extensive degree of parenchymal damage. Clinical factors related to prognosis in this series are age, hypoxia/hypotension, GCS motor score and pupillary abnormalities. Time from injury to treatment was found relevant only in patients with isolated SDH. CT findings on admission that correlated with outcome were haematoma thickness, midline shift and status of the basal cisterns. Prognosis was also worsened by the presence of associated lesions; SAH alone or associated with brain contusions. The last of these was the single most powerful predictor of worse outcomes (Odds ratio 0.37, p < 0.004). Whereas the first CT showed parenchymal associated damage in 56 patients, the 'worst CT' showed such damage in 105 patients. Presence of SAH on admission was found significant (p < 0.02) in predicting evolving parenchymal damage. Haematoma thickness, midline shift, status of the basal cisterns and presence of SAH are related to outcome when identified on the initial (early) CT examination. However, early (within 3 h from injury) CT under-estimates the ultimate size of parenchymal contusions. Patients with SAH on early CT are those at highest risk for associated evolving contusions. The use of sequential CT should be included in the routine management of head-injured patients.
急性创伤后硬膜下血肿（SDH）患者的影像学表现与预后的关系一直基于入院时的CT检查结果。本研究旨在调查入院时不存在但随后CT检查发现的病变对SDH患者预后的影响。我们还研究了入院CT上那些可预测相关病变恶化的表现。1989年5月1日至1996年4月30日，我们收治了206例急性SDH厚度达5mm或更厚的患者。入院时格拉斯哥昏迷评分（GCS）范围为3至15分。每位患者入院时均接受CT检查（总是在受伤后3小时内）。受伤后12 - 24小时及随后几天进行了随访CT检查（每位患者平均4.3次检查）。这些检查由神经放射科医生进行复查，并确定“最差”的CT图像。我们将“最差”检查定义为显示血肿厚度最大/中线移位和/或实质损伤程度最广泛的检查。本系列中与预后相关的临床因素包括年龄、缺氧/低血压、GCS运动评分和瞳孔异常。发现受伤至治疗的时间仅在单纯SDH患者中具有相关性。入院时与预后相关的CT表现为血肿厚度、中线移位和基底池状态。存在相关病变也会使预后恶化；单独的蛛网膜下腔出血（SAH）或伴有脑挫裂伤。其中脑挫裂伤是预后较差的最有力单一预测因素（比值比0.37，p < 0.004）。首次CT显示56例患者存在实质相关损伤，而“最差CT”显示105例患者存在此类损伤。发现入院时存在SAH在预测实质损伤进展方面具有显著性（p < 0.02）。当在初始（早期）CT检查中发现血肿厚度、中线移位、基底池状态和SAH的存在与预后相关。然而，早期（受伤后3小时内）CT低估了实质挫裂伤的最终大小。早期CT上存在SAH的患者是发生相关进展性挫裂伤风险最高的患者。连续CT的应用应纳入颅脑损伤患者的常规管理中。
