Prognostic Factors in Head-injured Patients with Traumatic Subarachnoid Hemorrhage

Gill, Seung Bae; Kim, Hun Joo; Hu, Chul; Han, Yong Pyo; Hong, Soon Ki; Pyen, Jhin Soo

Abstract

The presence of traumatic subarachnoid hemorrhage on the initial computerized tomographic scans has been known to be associated with worse results. By means of a simple and reliable computerized tomographic grade system proposed by Greene and his colleagues, prognostic factors of the traumatic subarachnoid hemorrhage was significantly related to clinical outcome at the time of discharge from acute hospitalization. Between February 1992 and August 1995, 3975 patients were admitted to our department of neurosurgery due to head injury. Clinical data were retrospectively reviewed to ascertain the relationship of the thickness of traumatic subarachnoid hemorrhage, its location, evidence of mass lesion(s), midline shift, obliteration of the basal cistern, and cortical sulcal effacement to outcome. Additionally, initial Glasgow coma scale score, arterial gas study, systemic blood pressure and prothrombin time were also analyzed for the same purpose. Among 3975 head-injured patients, 213 patients were identified to h ave traumatic subarachnoid hemorrhage on the initial computerized tomographic scan. Among 213 traumatic subarachnoid hemorrhage patients, the patients treated with calcium channal blocker(32 patients) and 3 patients lost to follow-up were excluded from this study for a total of 178. The computerized tomographic scan findings were divided into a 3 grade system;Grade 1 indicating only traumatic subarachnoid hemorrhage, Grade 2 indicating traumatic subarachnoid hemorrhage with mass lesion(s) , Grade 3 indicating traumatic subarachnoid hemorrhage with mass lesion(s) and midline shift. All these data were compared to Glasgow outcome scale on discharge, and arbitrarily these were divided into the good(good recovery and moderate disability) and the bad(severe disability, vegetative state and death). The authors conclude that the contributing factors to outcome at discharge were as follows:1. midline shift(p=0.002), PT< or =70%(p<0.001), obliteration of the basal cistern(p=0.001) and cortical sulcal effacement(p=0.001) were shown to the statistically significant. 2. initial computerized tomographic grade contributed to outcome at discharge.