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Neurosurgery. 2002 Feb;50(2):261-7; discussion 267-9.
Traumatic subarachnoid hemorrhage: demographic and clinical study of 750
patients from the European brain injury consortium survey of head injuries.
Servadei F , Murray GD, Teasdale GM, Dearden M, Iannotti F, Lapierre F, Maas AJ , Karimi A, Ohman J ,
Persson L, Stocchetti N, Trojanowski T, Unterberg A.
Divisione di Neurochirurgia per la Traumatologia, Ospedale Maurizio Bufalini, Cesena, Italy.
fservade@ausl-cesena.emr.it
Abstract
Previous reports identified the presence of traumatic subarachnoid hemorrhage (tSAH) on
admission computed tomographic (CT) scans as an independent prognostic factor in worsening outcomes.
The mechanism underlying the link between tSAH and prognosis has not been clarified. The aim of this study
was to investigate the association between CT evidence of tSAH and outcomes after moderate or severe
head injuries.
In a survey organized by the European Brain Injury Consortium, data on initial severity,
treatment, and subsequent outcomes were prospectively collected for 1005 patients with moderate or
severe head injuries who were admitted to one of the 67 European neurosurgical units during a 3-month
period in 1995. The CT findings were classified according to the Traumatic Coma Data Bank classification
system, and the presence or absence of tSAH was recorded separately in the initial CT scan forms.
Complete data on early clinical features, CT findings, and outcomes at 6 months were available
for 750 patients, of whom 41% exhibited evidence of tSAH on admission CT scans. There was a strong,
highly statistically significant association between the presence of tSAH and poor outcomes. In fact, 41% of
patients without tSAH achieved the level of good recovery, whereas only 15% of patients with tSAH
achieved this outcome. Patients with tSAH were significantly older (median age, 43 yr; standard deviation,
21.1 yr) than those without tSAH (median age, 32 yr; standard deviation, 19.5 yr), and there was a
significant tendency for patients with tSAH to exhibit lower Glasgow Coma Scale scores at the time of
admission. A logistic regression analysis of favorable/unfavorable outcomes demonstrated that there was
still a very strong association between tSAH and outcomes after simultaneous adjustment for age, Glasgow
Coma Scale Motor Scores, and admission CT findings (odds ratio, 2.49; 95% confidence interval,
1.74-3.55; P <0.001). Comparison of the time courses for 164 patients with early (within 14 d after injury)
deaths demonstrated very similar patterns, with an early peak and a subsequent decline; there was no
evidence of a delayed increase in mortality rates for either group of patients (with or without tSAH).
These findings for an unselected series of patients confirm previous reports of the adverse
prognostic significance of tSAH. The data support the view that death among patients with tSAH is related to
the severity of the initial mechanical damage, rather than to the effects of delayed vasospasm and
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Traumatic subarachnoid hemorrhage: demographic ... [Neurosurg... http://www.ncbi.nlm.nih.gov/pubmed/11844260
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secondary ischemic brain damage.
PMID: 11844260 [PubMed - indexed for MEDLINE]
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Traumatic subarachnoid hemorrhage: demographic ... [Neurosurg... http://www.ncbi.nlm.nih.gov/pubmed/11844260
2 of 2 10/3/2014 12:37 AM