Head trauma in polytrauma patients: computed tomography imaging findings and correlation with Glasgow coma scale

Objective: The most critical period for acute polytrauma patients with head injuries is first three days after ictus. Severity of head injuries and their early secondary progress could determine fatal outcome in this patient group. The aim of our study was to determine frequency and kind of early secondary intracranial injuries CT signs developed in acute polytrauma patients and their impact on survival.
Methods: A retrospective one-year study included in general 264 polytrauma patients, admitted at Riga East Clinical University hospital, Intensive care unit and primary scanned using original standardized CT polytrauma protocol. From them, 75 polytrauma patients, having acute intracranial traumatic CT signs were selected for father neuroradiologic analysis and research. In 32 patients with clinical deterioration repeated head CT scans using standardized head CT protocol were performed within the first 5 days. CT images were analysed in soft tissue and bone windows independently by two physicians: ESNR board certified neuroradiologist and radiologist-in-training, conclusions were reached by consensus. Statistical data analysis was processed using IBM SPSS Statistics. A chi-square test was used to find associations between modalities. A p-value Results: 32 patients (M=44.9 years, min=16, max=82; SD=18.5) underwent follow-up CT within 5 days after primary CT due to worsening of neurological state; 27 of them (84%) underwent head CT within the first two days. 9 patients (28%) of the study group underwent urgent operative intervention, the remaining patients received conservative treatment. Negative dynamics were found on control CT in 16 (50%) of cases, including increase size of haemorrhagic foci, their multiplicity; increase of perifocal edema volume - 11 cases; appearance of IVH in 3 cases, extension of SAH in 4 patients; increase of SDH in 2 cases and increased volume of EDH in 1 case. Secondary cerebral ischaemia was found in 3 patients, global cerebral oedema and cerebral herniation in 2 cases. Statistically, there was a tendency between SAH progression and an increase of haemorrhagic contusion volume (p=0.007). The in-hospital recovery rate in the study group was 78%, in-hospital mortality 19%. Simultaneous progression of several types of intracranial traumatic pathology correlated with higher mortality (p=0.01).
Conclusions: The severity of head trauma with early progression may play a leading role of death in acute polytrauma patients. Timely repeated head CT follow-up within the first 5 days in severe acute polytrauma patients is a sensitive and highly important diagnostic tool for emergency neurosurgical planning and intensive care selection.