The predictive value of ICP as compared to magnetic resonance imaging in comatose patients after head injury.

ABSTRACT

INTRODUCTION: While highly increased intracranial pressure (ICP) is of high predictive value indicating a fatal outcome, the predictive value of moderately increased ICP early after head injury remains uncertain. We compared the predictive value of ICP to the predictive value of magnetic resonance imaging (MRI) early after head injury. METHODS: 55 patients with a Glasgow Coma Scale (GCS) of less than 8, for more than 24 hours after head injury were investigated. Outcome was classified according to the Glasgow Outcome Scale (GOS). All patients received registration of ICP upon arrival at the hospital and an initial cranial computerized tomography scan. An MRI study was subsequently performed within 10 days of admission. The highest mean ICP registered within one hour in the first day of admission and the location of lesions as identified by MRI were related with outcome. RESULTS: ICP was neither related with mortality nor with GOS of survivors. The location of lesions as depicted by MRI proved to be statistically significantly related with the GOS (p < 0.001). Age proved to be clearly and significantly related with outcome (p = 0.019). CONCLUSIONS: Our current MRI findings suggest that the location of the initial brain injury lesion correlates with outcome at 6 months. No such correlation could be identified for intracranial pressure on the first day after head injury (p = 0.766).