title: 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.
abstract: OBJECTIVE
  The goal of this study was fourfold: 1) to determine the incidence of traumatic subarachnoid hemorrhage (tSAH) in patients with traumatic brain injury (TBI); 2) to verify agreement in the diagnosis of tSAH in a multicenter study; 3) to assess the incidence of tSAH on the outcome of the patient; and 4) to establish whether tSAH itself leads to an unfavorable outcome or whether it is a sign of major brain trauma associated with severe posttraumatic lesions.
  
  
  METHODS
  Computerized tomography (CT) scans obtained in 169 head-injured patients on admission to 12 Italian intensive care units during a 3-month period were examined. The scans were collected for neuroradiological review and were used for the analysis together with data from a multicenter database (Neurolink). A review committee found a high incidence of tSAH (61%) in patients with TBI and a moderate agreement among centers (K = 0.57). Significant associations were observed between the presence and grading of tSAH and patient outcomes, and between the presence of tSAH and the severity of the CT findings. Logistic regression analysis showed that the presence of tSAH and its grading alone do not assume statistical significance in the prediction of unfavorable outcome.
  
  
  CONCLUSIONS
  Traumatic SAH frequently occurs in patients with TBI, but it is difficult to detect and grade. Traumatic SAH is associated with more severe CT findings and a worse patient outcome.
authors.affiliation: Neurointensive Care Unit, Neuroradiology Department, IRCCS H. San Raffaele, Milano, Italy. mattioli.cristina@hsr.it
authors.forename: Cristina
authors.initials: C
authors.lastname: Mattioli
authors.forename: Luigi
authors.initials: L
authors.lastname: Beretta
authors.forename: Simonetta
authors.initials: S
authors.lastname: Gerevini
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Veglia
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Citerio
authors.forename: Manuela
authors.initials: M
authors.lastname: Cormio
authors.forename: Nino
authors.initials: N
authors.lastname: Stocchetti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020206:Subarachnoid Hemorrhage, Traumatic / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices