title: Head computed tomographic measurement as a predictor of outcome in patients with subdural hematoma with cerebral edema.
abstract: BACKGROUND
  The ability to predict outcome in patients with cerebral edema is important because it can influence treatment strategy. We evaluated whether differences in head computed tomographic (CT) measurements in Hounsfield units (HU) of white matter and gray matter can be used as a predictor of outcome in patients with subdural hematoma with cerebral edema.
  
  
  METHODS
  We evaluated 34 patients who had subdural hematoma with cerebral edema following acute closed head trauma and had undergone head CT within a few hours of admission. We divided them into the survival (n = 24) group and death (n = 10) group, and measured the HU of white matter and gray matter at injury and non-injury sites.
  
  
  RESULTS
  There were no significant differences in operation time or blood loss during surgery between the two groups. Only the HU of white matter in the injury site of patients in the death group were decreased significantly. A cut-off value of 31.5 for HU of white matter showed 80.0 % sensitivity and 99.9 % specificity for death; the area under the curve was 0.91.
  
  
  CONCLUSIONS
  Our results are more evidence of the support of neurogenic edema in trauma rather than an important clinical tool at this stage. However, HU values in WM may be one factor in the decision-making process that affects patient outcome. Changing the treatment strategy in patients with a low HU value in the WM at the injury site may bring about an improvement in patient outcome.
  
  
  CONCLUSIONS
  Measurement in HU of white matter at the injury site might be useful as a predictor of outcome in patients with subdural hematoma with cerebral edema.
authors.affiliation: Department of Critical Care Medicine, Graduate School of Medicine, Hirosaki University, 5 Zaifuchou, Hirosaki city, Aomori, 036-8562, Japan. yamamura@hirosaki-u.ac.jp.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yamamura
authors.affiliation: Department of Critical Care Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Osaka City, 545-8585, Japan.
authors.forename: Takasei
authors.initials: T
authors.lastname: Morioka
authors.affiliation: Department of Critical Care Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Osaka City, 545-8585, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Critical Care Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Osaka City, 545-8585, Japan.
authors.forename: Yasumitsu
authors.initials: Y
authors.lastname: Mizobata
mesh_terms: D000368:Aged; D001929:Brain Edema / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D005260:Female; D066128:Gray Matter / Q000000981:diagnostic imaging*; D016489:Head Injuries, Closed / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006408:Hematoma, Subdural / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed / Q000379:methods*; D015599:Trauma Severity Indices; D066127:White Matter / Q000000981:diagnostic imaging*