An Evaluation Of The Prognostic Value Of Traumatic Subarachnoid Hemorrhage To Marshall's Computerized Tomography (CT) Classification In Patients With Severe Traumatic Brain Injury

Background:CT characteristics including the Marshall's CT classification and traumatic subarachnoid hemorrhage (tSAH) are two of the most powerful independent prognostic variables in patients with severe traumatic brain injury. However, tSAH is not concluded in Marshall's CT classification, do we need to revise Marshall's CT classification to achieve greater reliability and sensitivity because of the influence of tSAH?Method:We performed a prospective analysis of cases with severe tiaumatic brain injury in inpatients between february 2009 and july 2009, the incidence of tSAH and its relationship with outcome as well as the prognostic influence with tSAH to Marshall's CT classification of suffusion group and location group. For patients'outcome with GOS score, cases were divided into "good recovery" and "bad recovery" groups, and related clinical factors with potential impact on prognosis were analyzed.Results:In all 66 patients with severe traumatic brain injury, the incidence of tSAH is 77.27% and the outcome of patients with tSAH is significantly worse than those without tSAH. According to Marshall's CT classification of suffusion group, the average score of GOS at 6 months after trauma was 3.26, and the average score with tSAH was 3.00, without tSAH was 4.25. In location group, the average score of GOS at 6 months after trauma was 2.19, and the average score with tSAH was 1.91, without tSAH was 3.00. There was statistically difference between with tSAH and without tSAH (p<0.05). In this prospective research, factors such as a patient's GCS score, age and temperature are strongly correlated with the patient's outcome of GOS score at 6 months after trauma (P<0.05), however, according to logistic regression analysis a patient's GCS score and age are significant independent outcome predictors, and temperature does not assume statistical significance in the prediction of unfavorable outcome.Conclusions:Traumatic subarachnoid hemorrhage (tSAH) is very common in patients with severe traumatic brain injury and it is an independent outcome predictor of CT characteristic according to Marshall's CT classification and there should be a concerted effort to revisit or revise the classification to achieve greater reliability and sensitivity in further researches. Patients with lower GCS score, aged and hyperthermia may have a worse outcome and prevention of hyperthermia may improve the outcome of patients with severe head injury.