Establishment Of Critical Values And Quality Control Path Evaluation System Of Craniocerebral Injury Image

Objective:To investigate and analyze the500cases of acute brain injurywhich were admitted in our hospital from September2011to September2012,compare the injury type, injury scope and other imaging features of them,connected with clinical symptoms, set up relative imaging emergency valueevaluation system, in order to give a guidance to the clinical treatment andprediction to the risk extent of various type of acute brain injury.Methods:1Collected500cases of acute brain injury that were admitted in ourhospital and taken imaging examination such as computed tomography (CT)or magnetic resonance imaging (MRI)in our imaging department.2Grouping the patients based on their severity of brain injury by imagingexamination,204cases were simple brain injury,296cases were compoundinjury, divided the patients into subgroup based on their age, analysis theimaging data, evaluated their area of cerebral hematoma/the extend of midlineshift/location of hematoma/area of subarachnoid hemorrhage and cranialfracture, analyze their relationship with the urgency of their disease, evaluatedthe severity of the injury.3According to the imaging data, we preliminarily evaluated the patients’urgency of injury. The detail evaluation standard were as below: scalp injury-including scalp hematoma/scalp laceration or scalp avulsion score1point;skull fracture-linear fracture including anterior fossa/middle fossa/posteriorfossa fracture score2points, depressed fracture score3points; Intracerebralhematoma-epidural hematoma: hematoma arc was more than1/4circle abovethe tentorium cerebelli score4points, hematoma arc was less than1/4circleabove the tentorium cerebelli score3points, hematoma arc was more than1/4circle under the tentorium cerebelli score5points, hematoma arc was less than 1/4circle under the tentorium cerebelli score4points; subdural hematoma:hematoma area more than circle score5points, hematoma area were1/4to1/5circle score4points, hematoma area less than1/5circle score3points;Compression of the third ventricle: Normal is0points, reduced is1points,disappeared for2; midline shift: normal for0points, the shift is less than5mmfor1points,2points in between6～10mm shift, shift for3points in the11～15mm, more than15mm displaced for4points; The lateral ventriclecompression: normal for0points, unilateral deformation to mostly disappearfor1points, bilateral deformation to mostly disappear for2points, bilateraldisappeared to disappear completely for3points; quadrigeminal cistern,cistern and ring pool compression: normal count for0point, smaller count for1point, disappear for2; brain contusion and laceration: local contusion andlaceration of brain is2points, diffuse brain contusion and laceration was3;the situation of subarachnoid hemorrhage: the presence of subarachnoidhemorrhage was2points, absence for0points. According to the grading ofacute brain injury patients were given emergency classification, divided intothree levels,18-26is divided into third degree-Ⅲ brain injury,9-17is dividedinto Ⅱ critical brain injury,0-8is divided into gradeⅠcritical brain injury.The scoring criteria was uses for500patients with acute brain injury, at thesame time, GCS score and the clinical symptoms of all patients were analyzed,in order to find out its consistency, and make the corresponding adjustment.Results:1In500patients with acute brain injury patients between the ages of2-76years old, the average age is34.5years old, were divided into childhoodgroup (0-7years old) in32cases, the juvenile group (7-20years old),104cases of youth group (20-45years old) in197cases, the middle-aged group(45-60years old) in103patients, aged group (aged>60years) in64cases.Clinical manifestations:161cases of patients were with clearconsciousness, consciousness of128cases were fuzzy, the reaction ability tothe external reduced, language and cooperation ability reduced, but they werenot completely disappeared, they were indifferent, dull, lethargy, language disorder, directional obstacle, agitation, delirium or enuresis;106patients withsuperficial coma, patients has no reaction on language, still sensitive to thepain, when given pain stimulus the patients can reacted with simple defensiveaction or evasive action or only frown;89cases were in coma, their painreaction has been relatively slow, voluntary action has completely lost, thepatients can show snoring, retention of urine the performance, the pupil ofoptical reflection and corneal reflection;16cases of patients were in deepcoma, manifested as pain completely disappeared, bilateral mydriasis, the lightreflection and corneal reflection were lost;403patients perceived headache,381patients felt nausea and vomiting,162cases of patients were withpyramidal sign,57cases were with hemiparalysis,158cases of patients werewith aphasia,276cases of patients were with basic vital signs of disorder suchas high blood pressure, tachycardia and fever.500patients underwent CT scanning,329cases were examined with MRI,the scans showed,367patients with cerebral contusion and laceration, thecharacteristics of CT image for the low density of brain edema zone, scatteredhemorrhage foci in high density, with mass effect, and some showed diffusecerebral edema and brain edema;248cases of patients were with subduralhematoma, the CT image shows under cranial plate there are high densityrange of spindle or semicircular shape, not across the cranial suture;184patients with subdural hematoma, the characteristics of CT image were underthe cranial plate there are crescent or half-moon shape high density area;271cases of patients with subarachnoid hemorrhage, CT images show the densityof cerebral sulcus, cerebral pool increased;185patients with midline shift;142cases of patients with the third ventricle reduced,23cases of patients withthe third ventricle disappeared;59patients with quadrigeminal cistern, cisternand ring pool become smaller,21patients with quadrigeminal cistern\footpond and ring pool disappeared;279patients with lateral ventricularnarrowing,27cases of patients with lateral ventricle disappeared;19patientshad hematoma of scalp, scalp laceration or scalp avulsion;105patients withfracture of skull, the characteristics of CT image was among high-density Skull Bone there were linear low density or depressed low density shadow,discontinuous. skull shadow.2according to the emergency rating standards, emergency score of500patients with acute brain injury were given.164cases were level as the Ⅲdegree critical brain injury (18-26) in the average score was (23.2±2.4); IIcritical brain injury (9-17) in218cases, the average score was (13.5±3.2); Idegree critical brain injury (0-8) in118cases, the average score was (4.2±2.9)points. According to Glasgow score standard, mild traumatic brain injury(13-15) in133cases, the critical values for the mean value (5.1±1.2);moderate brain injury (8-12) in224cases, the critical values for the meanvalue (12.8±3.4); severe brain injury (3-7) for in143cases, the critical valuesfor the mean value (22.7±2.2).Compare the emergency score of Ⅲ degree, II degree, I degree criticalbrain injury‘s emergency score with Glasgow coma score of severe, moderate,mild brain injury respectively, results showed that there were no significantdifferences between the two scoring system,and they shows high correlation,(III degree vs severe, P=0.28; second degree vs moderate, P=0.06; I vs light,P=0.09, r=0.87).Third degree critical brain injury in58cases died in thehospital, invalid in28patients,78patients become better, the hospitalmortality was35.37%;7cases in II critical brain injury died in the hospital,invalid in11patients,200patients become better, the hospital mortality was3.21%;1cases in first degree critical brain injury died in the hospital,117patients left hospital, the hospital mortality was0.85%; analysis of emergencyscore of the patients and in hospital mortality, the results showed goodcorrelation (r=0.82, P=0.02).Conclusion:Emergency ratings can be graded on the basis of criticalitycharacteristics in patients with CT in the image of their conditions, there is asignificant correlation between emergency score and GCS score, and had ahigher correlation with hospital mortality, so it may be used as emergencyscore for acute brain injury patients, in order to guide the diagnosis andtreatment, and improve the treatment of patients with acute brain injury, it is beneficial to the diagnosis of acute brain injury and grading the severity of thedisease and the timing of the operation, it can be used as an auxiliary tool forsafe and effective diagnosis and treatment.