8th Baltic Congress of Radiology

Neuroradiology

poster abstract

Polytrauma is a term used to describe acute trauma patients with two or more severe injuries in at least two areas of the body. An accurate patient assessment is mandatory. Glasgow coma scale (GCS) is used for the assessment of impaired conscious level in a person after a brain injury. According to GCS, brain injury is classified as mild (15-14), moderate (13-9), and severe (8-3). Computed tomography (CT) is the standard diagnostic method in the emergency department to evaluate head injuries. The aim of this study was to evaluate whether there is an association between established head traumatic changes seen in CT and the GCS results.

Polytrauma patients who were hospitalized in the Emergency room of Riga East University Hospital from 1st of January to 31st of December 2019 and underwent CT scans using polytrauma protocol were retrospectively analyzed. Included patients had one or more head injuries present in the CT scan. Selected polytrauma patient CT images and corresponding radiological reports were independently reviewed by three radiological residents in training with board-certified neuroradiologist and information about soft tissue damage, cranial bone fractures, intracranial hemorrhages, and brain contusions was evaluated until reaching a consensus. Information about the patient's age, gender, trauma mechanism, outcome, and GCS score at admission were acquired from the medical history. All acquired data were summarized using MS Excel. Correlations and associations between CT findings and GCS were performed in SPSS 25.0 using Spearman's rank correlation coefficient and the Chi-square test. P<0,05 were considered statistically significant.

From 264 patients, 75 (53 males, 22 females) were selected for further analysis (median age 47). Three most common mechanisms of injury were traffic accidents – driver (24%, n=18), pedestrian (20%, n=15) and fall from a height (25,3%, n=19). Other mechanisms accounted for 17,3% (n=13). In 13,3%, (n=10) the mechanism of injury could not be elucidated. Based on GCS results 46,7% (n=35) had mild brain injury, 13,3% (n=10) moderate and 29,3% (n=22) severe brain injury. In 10,7% (n=8) GCS data were not available. From all patients 41,3% (n=31) had no cranial bone fractures. The most common bone fractures were facial bone 16% (n=12), followed by skull base 9,3% (n=7), skull vault 6,7% (n=5), skull base and vault 6,7% (n=5), facial bone and skull base 5,3% (n=4), facial bone and skull vault fractures 4% (n=3). In 10,7% (n=10) cases all areas were affected. In 38,7% (n=29) no intracranial hematomas were present. Epidural hematoma (EDH) was present in 5,3% (n=4) cases, subdural hematoma (SDH) in 33,3% (n=25) cases, subarachnoid hematoma (SAH) in 50,7 % (n=38), intracerebral hematoma (ICH) in 10,7% (n=8) and intraventricular hematoma (IVH) in 10,7% (n=8) cases. Most common hematoma combination was SDH and SAH present in 16% (n=12) of cases. No cerebral contusions were present in 70,7% (n=53) cases, coup lesions were present in 13,3% (n=10) cases, contrecoup in 9,3% (n=7) cases and bilateral in 6,7% (n=5) cases. Mortality was 20% (n=15) despite treatment, and 78,7% (n=59) were discharged. One patient refused treatment. Weak negative statistically significant correlation was found between GCS and the number of hematoma variations (rho= -0,368; p=0,002). Statistically significant associations were noted between patients with severe brain injury according to GCS and os palatinum (p=0,009) and os ethmoidale (p=0,019) fractures, presence of EDH (p=0,019), ICH (p=0.048), IVH (p=0,047) and lethal outcome (p<0,001). No other significant correlations or associations were found.

More often patients acquire head injuries in road accidents as drivers or pedestrians. The variation in head fractures didn’t show any trend and had variable combinations. The most common intracranial hematomas were SDH and SAH. They also were often observed together. Brain contusions were less common than other traumatic injuries. Most of the patients recovered from the injuries, but one-fifth did not survive. After the comparison of GCS score with CT findings we observed that an increased number of hematoma types was more likely associated with a lower GCS score fixed at patient admission. Patients with severe brain injury according to GCS more often was found os ethmoidale, os palatinum fractures, and epidural, intracerebral, and intraventricular hematomas. However, we only assessed cranial injuries, so it cannot be ruled out that GCS scores were not affected by traumatic injuries to other parts of the body, such as intra-abdominal or intrathoracic active bleeding.

Polytrauma patients often experience head trauma and an altered Glasgow coma scale (GCS) that classifies brain injury into three groups: mild (15-14), moderate (13-9), and severe (8-3). In a retrospective one-year study, 75 out of 264 polytrauma patients had CT-confirmed head injuries. An increase in hematoma variants was associated with a lower GCS score and more often had os ethmoidale and os palatinum fractures, and epidural, intracerebral, and intraventricular hematomas.

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