Marshall et al. described diagnostic categories by CT scanning that improve prognostic discrimination and permit more homogeneous comparisons (Table 2.3). With clinical data (Traumatic Coma Data Bank, TCDB) this scale gives better
Table 2.3 Mortality by individual categories in TCDB (Traumatic Coma Data Bank) classification of brain CT. Note that classes are not mutually exclusive
Imaging the brain - CT Scan Mortality (%)
Diffuse injury I (no visible lesion) 9-6
Diffuse Injury II 13-5
Diffuse Injury III (swelling) 34
Diffuse Injury IV (shift) 56-2
Evacuated mass 38-8
Non-evacuated mass 52-8
Brain-stem injury 66-7
classification of "at risk" groups and has promoted the development of management guidelines, identifying subgroups so that new therapies can be appropriately targeted and revision of current thinking facilitated.66 Lobato et al. attempted to identify common patterns of CT change and to validate the TCDB classification through sequential CT changes, and relating these to final outcome in severe head injury patients.65,67,68 The final outcome was more accurately predicted using a CT scan at 48 hours than by using the initial CT scans. Because the majority of relevant CT changes developed within 48 hours after injury a pathological categorisation made by using an early elective control CT scan seems to be most useful for prognostic purposes (Figure 2.1, Table 2.3).
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