title: Computed tomography and clinical outcome in patients with severe traumatic brain injury.
abstract: To study: (i) acute computed tomography (CT) characteristics and clinical outcome; (ii) clinical course and (iii) Corticosteroid Randomisation after Significant Head Injury acute calculator protocol (CRASH) model and clinical outcome in patients with severe traumatic brain injury (sTBI).
  
  
  
  Initial CT (CTi) and CT 24 hours post-trauma (CT24) were evaluated according to Marshall and Rotterdam classifications. Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) and Glasgow Outcome Scale Extended (GOSE) were assessed at three months and one year post-trauma. The prognostic value of the CRASH model was evaluated.
  
  
  
  Thirty-seven patients were included. Marshall CTiand CT24were significantly correlated with RLAS-R at three months. Rotterdam CT24was significantly correlated with GOSE at three months. RLAS-R and the GOSE improved significantly from three months to one year. CRASH predicted unfavourable outcome at six months for 81% of patients with bad outcome and for 85% of patients with favourable outcome according to GOSE at one year.
  
  
  
  Neither CT nor CRASH yielded clinically useful predictions of outcome at one year post-injury. The study showed encouragingly many instances of significant recovery in this population of sTBI. The combination of lack of reliable prognostic indicators and favourable outcomes supports the case for intensive acute management and rehabilitation as the default protocol in the cases of sTBI.
authors.affiliation: a Department of Community Medicine and Rehabilitation , Rehabilitation Medicine.
authors.forename: Maud
authors.initials: M
authors.lastname: Stenberg
authors.affiliation: b Department of Pharmacology and Clinical Neuroscience , Neurosurgery.
authors.forename: Lars-Owe D
authors.initials: LD
authors.lastname: Koskinen
authors.affiliation: c Department of Radiation Sciences, Diagnostic Radiology , Umeå University , Umeå , Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Jonasson
authors.affiliation: d Department of Rehabilitation Medicine , Linköping University , Linköping , Sweden.
authors.forename: Richard
authors.initials: R
authors.lastname: Levi
authors.affiliation: a Department of Community Medicine and Rehabilitation , Rehabilitation Medicine.|e Department of Clinical Sciences , Danderyd University Hospital, Division of Rehabilitation Medicine, Karolinska Institutet , Stockholm , Sweden.|f Department of Rehabilitation Medicine , Danderyd Hospital , Stockholm , Sweden.
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Stålnacke
mesh_terms: D000293:Adolescent; D000328:Adult; D000647:Amnesia / Q000209:etiology; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015331:Cohort Studies; D003243:Consciousness / Q000502:physiology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Computed tomography; outcome; severe traumatic brain injury