The value of the "worst" computed tomographic scan in clinical studies of moderate and severe @entity542 . European XXXX Consortium.

@entity1 @entity1545 @entity131 @entity66 @entity75 @entity542 @entity772 @entity1613
OBJECTIVE: Computed tomographic (CT) scanning can reveal the pattern and severity of structural @entity75 after @entity542 . With the proliferation of CT scanners in general hospitals, and with improvements in @entity1 transport, the interval from injury to the first CT scan is decreasing. The potential result is an "admission" scan missing an evolving and potentially operable lesion. Furthermore, the literature is confusing regarding the timing and coding of CT findings. We sought to establish the frequency of deterioration in CT appearance from an admission scan to subsequent scans and the prognostic significance of such deterioration. METHODS: In a survey organized by the European @entity1545 Consortium, data on initial severity, management, and subsequent outcome were gathered prospectively for 1005 @entity1 with moderate or severe @entity542 admitted to one of 67 European neurosurgical units during a 3-month period in 1995. The findings of the @entity1613 scan were classified according to the @entity772 Data Bank system and were related to outcome as assessed using the Glasgow Outcome Scale 6 months after injury. RESULTS: Data on an initial and a final CT scan were available for 897 @entity1 ; of these, 724 @entity1 were assessed using the Glasgow Outcome Scale at 6 months. The initial CT findings were classified as a @entity131 for 53% of the cohort, with 16% of these @entity131 demonstrating deterioration on a subsequent scan. In 56 (74%) of 76 deteriorations, the change was from a @entity131 to a @entity66 . When the initial CT scan demonstrated a @entity131 without swelling or shift, evolution to a @entity66 was associated with a statistically significant increase in the risk of an unfavorable outcome (62% versus 38%). When the initial scan demonstrated evidence of swelling or shift, there was a nonsignificant trend in the opposite direction, although the numbers were limited. CONCLUSION: When an admission CT scan demonstrates evidence of a @entity131 , follow-up scans should be performed, because approximately one in six such @entity1 will demonstrate significant CT evolution. In studies comparing series of head-injured @entity1 , correspondence of timing of CT scans is necessary for valid comparison.
