This study was designed to evaluate whether the maximum thickness of subarachnoid blood is an independent prognostic marker of mortality after traumatic subarachnoid haemorrhage. Multivariate analysis showed the maximum thickness of subarachnoid blood was an independent predictor of death versus survival 1 month after injury and was inversely associated with Glasgow Coma Scale (GCS) score. Receiver operating characteristic curve analysis showed that maximum thickness of subarachnoid blood > 6.7 mm immediately after non-surgical resuscitation predicted 1-month mortality with 83.9% sensitivity and 67.1% specificity; its predictive value was similar to that of the GCS score. Addition of maximum thickness of subarachnoid blood to the GCS score did not significantly improve predictive performance. Hence, the maximum thickness of subarachnoid blood is a new independent prognostic marker of mortality and might become an additional, valuable tool for risk stratification and decision making in the acute phase of traumatic subarachnoid haemorrhage.
HussonECRibbersGMWillemse-van SonAH: Prognosis of six-month functioning after moderate to severe traumatic brain injury: A systematic review of prospective cohort studies. J Rehabil Med2010; 42: 425–436.
2.
MarmarouALuJButcherI: Prognostic value of the Glasgow Coma Scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis. J Neurotrauma2007; 24: 270–280.
3.
FabbriAServadeiFMarchesiniG: Early predictors of unfavourable outcome in subjects with moderate head injury in the emergency department. J Neurol Neurosurg Psychiatry2008; 79: 567–573.
4.
MosenthalACLivingstonDHLaveryRF: The effect of age on functional outcome in mild traumatic brain injury: 6-month report of a prospective multicenter trial. J Trauma2004; 56: 1042–1048.
5.
Willemse-van SonAHRibbersGMVerhagenAP: Prognostic factors of long-term functioning and productivity after traumatic brain injury: A systematic review of prospective cohort studies. Clin Rehabil2007; 21: 1024–1037.
6.
ForemanBPCaesarRRParksJ: Usefulness of the abbreviated injury score and the injury severity score in comparison to the Glasgow Coma Scale in predicting outcome after traumatic brain injury. J Trauma2007; 62: 946–950.
7.
AsikainenIKasteMSarnaS: Predicting late outcome for patients with traumatic brain injury referred to a rehabilitation programme: A study of 508 Finnish patients 5 years or more after injury. Brain Inj1998; 12: 95–107.
8.
PaivaWSde AndradeAFde AmorimRL: The prognosis of the traumatic subarachnoid hemorrhage: A prospective report of 121 patients. Int Surg2010; 95: 172–176.
9.
ArminSSColohanARZhangJH: Traumatic subarachnoid hemorrhage: our current understanding and its evolution over the past half century. Neurol Res2006; 28: 445–452.
10.
ServadeiFMurrayGDTeasdaleGM: Traumatic subarachnoid hemorrhage: demographic and clinical study of 750 patients from the European brain injury consortium survey of head injuries. Neurosurgery2002; 50: 261–267.
11.
EisenbergHMGaryHEJrAldrichEF: Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg1990; 73: 688–698.
12.
MattioliCBerettaLGereviniS: Traumatic subarachnoid hemorrhage on the computerized tomography scan obtained at admission: A multicenter assessment of the accuracy of diagnosis and the potential impact on patient outcome. J Neurosurg2003; 98: 37–42.
13.
KakariekaABraakmanRSchakelEH: Clinical significance of the finding of subarachnoid blood on CT scan after head injury. Acta Neurochir (Wien)1994; 129: 1–5.
14.
GreeneKAJacobowitzRMarcianoFF: Impact of traumatic subarachnoid hemorrhage on outcome in nonpenetrating head injury. Part II: relationship to clinical course and outcome variables during acute hospitalization. J Trauma1996; 41: 964–971.
15.
ChieregatoAFainardiELabateAM Morselli: Factors associated with neurological outcome and lesion progression in traumatic subarachnoid hemorrhage patients. Neurosurgery2005; 56: 671–680.
16.
MikiTIkedaYUtsugiO: Evaluation of traumatic subarachnoid haemorrhage on computed tomography. J Clin Neurosci1998; 5: 49–57.
17.
GreeneKAMarcianoFFJohnsonBA: Impact of traumatic subarachnoid hemorrhage on outcome in nonpenetrating head injury. Part I: A proposed computerized tomography grading scale. J Neurosurg1995; 83: 445–452.
18.
WongGKYeungJHGrahamCA: Neurological outcome in patients with traumatic brain injury and its relationship with computed tomography patterns of traumatic subarachnoid hemorrhage. J Neurosurg2011; 114: 1510–1515.
19.
MarshallLFMarshallSBKlauberMR: A new classification of head injury based on computerized tomography. J Neurosurg1991; 75 (suppl): S14–S20.
20.
AaslidRMarkwalderTMNornesH: Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg1982; 57: 769–774.
MoppettIK: Traumatic brain injury: assessment, resuscitation and early management. Br J Anaesth2007; 99: 18–31.
24.
FreytagE: Autopsy findings in head injuries from blunt forces. Statistical evaluation of 1,367 cases. Arch Pathol1963; 75: 402–413.
25.
LindenbergRFreytagE: Brain stem lesions characteristic of traumatic hyperextension of the head. Arch Pathol1970; 90: 509–515.
26.
KakariekaABraakmanRSchakalEH: Clinical significance of the finding of subarachnoid blood on CT scan after head injury. Acta Neurochir (Wien)1994; 129: 1–5.
27.
KobayashiS: Classification of computerized tomography and prognosis of traumatic primary brain stem injury. Neurol Med Chir1982; 22: 838–848 [in Japanese, English abstract].
28.
ZimmermanRABilanjukLTGenarelliT: Computed tomography of shearing injuries of the cerebral white matter. Radiology1987; 127: 393–396.
29.
FisherCMKistlerJPDavisJM: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery1980; 6: 1–9.
30.
ClaassenJBernardiniGLKreiterK: Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke2001; 32: 2012–2020.
