Clinical assessment of serial computerized tomography scanning in severe head injury.

Nowadays computerized tomography (CT) is widely used in th diagnosis and care of patients with severe head injuries because of its safety, speed, and function to allow visualization of the entire intracranial area'" . In particular, serial CT scanning (SCT) , performed several times after the initial CT, can visualize the dynamics of morphological changes in severe head injuries, hitherto only revealed by surgery or autopsy'". That is to say, SCT can detect the pathological changes, which have developed after the initial CT was taken and therefore was not revealed by the initial CT . SCT has been studied mainly in the case of the so-called "delayed traumatic intracerebral hematomas". The purpose of this study is to know whether or not there is a correlation between the changes revealed by SCT and the outcomes of severe head injuries. During the period of four and a half years from April, 1977, to September, 1981, 492 atients [257 with severe head injuries ; 8 or less on the Glasgow Coma Scale) were examined with CT within 24 hours of their injury (the majority within several hours) in the Department of Critical Care Medicine and Neurosurgery of the Nippon Medical School, Sendagi, Tokyo, Japan. SCT procedures were as follows . As a rule CT was carried out upon admission (within the order of hour after the injury) , and 1, 3, 7 days and 1 month later. Further CTs were carried out depending upon the conditions of patients . The authours performed SCT on 138 patients suffering from severe head injuries . The tomography was done using an EMI CT 1010 scanner with a 160 x 160 matrix . The patients' states on admission were graded on the Glasgow Coma Scale (GCS) " and clinical results at the time of discharge on the Glasgow Outcome Scale' . Patients who died and those who were in a persistent vegetative state, or severely disabled were put under the category of "bad outcome". On the other hand, patients who remained moderately disabled or showed good recoveries were put under the category of "good outcome" . The patients' states on admission were 8 or less on GCS (8 : 7 cases, 7 : 27 cases, 6: 44 cases, 5 : 26 cases, 4: 18 cases, 3 : 16 cases) . The mean GCS for the 72 patients with good outcomes was 6.22 and the mean GCS of the 66 patients with bad outcomes was 4 .80. In 91 of the 138 patients, SCT revealed the changes which were not detected by the initial CT. These changes were classified as follows; C) decreased density collection in the