Review Article | DOI: https://doi.org/10.31579/2578-8868/003
1 University of Calgary, Calgary, AB, Canada.
*Corresponding Author: Raghunath Avanali, University of Calgary, Calgary, AB, Canada.
Citation: Raghunath Avanali, Formulation of a Three-Tier Cisternal Grade as a Predictor of In-Hospital Outcome from a Prospective Study of Patients with Traumatic Intracranial Hematoma- A review report.J Neuroscience and Neurological Surgery.DOI : 10.31579/2578-8868/003
Copyright: ©2018 Dr. Raghunath Avanali, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 28 February 2018 | Accepted: 15 March 2018 | Published: 19 March 2018
Keywords: Keywords
Abstract
Traumatic brain injury (TBI) is an escalating problem with an almost geometric progression. The problem escalated with increasing population and traffic, but with limited resources to handle the issue.1,2 The present study has its objective focused on making a prognosis of the TBI patient.3 The outcome prediction helps in conveying the prognosis to the patient’s family. Needless to say, a prognostic prediction is also helpful in the optimal and timely utilization of available resources.
There have been various attempts made in the past towards making a prognostication of patients with TBI. The multi-central large population studies of CRASH (Corticosteroid Randomization After Significant Head Injury, sponsored by the Medical Research Council) study and the international mission on prognosis and clinical trial design in TBI (IMPACT) has enabled high-accuracy Web-based prediction models.4,5 The latest article introduced the three tier cisternal grade3 in the prognosis of TBI which is simple and overall takes less time. Hence it can be used by junior doctors, nursing and even paramedical staff.
Advantages of this study being, it do not have the significant observer bias, because of simplification of cisternal assessment as absent or present in contrast to various other scoring systems which have used partial compression, present or absent.6-8 Another strong point is inclusion of all the nine (six perimesencephalic and three anterior) cisterns in comparison to other studies which have used only perimesencephaliccisterns.6,9In practice the sum of the 9 cisterns, otherwise called the total cisternal score, can be easily fitted into 1 of the 3 levels. Expected outcome at each level can be predicted.Prognosis using three tier grade is based on initial CT Head (Computed tomography scan) which is a mandatory investigation in all cases of TBI and does not require MRI which is costly, time consuming and not used generally as the first line of investigation.Authors have excellently used statistical formulas to remove all the confounding factors and documented strong specificity and sensitivity for the grades.
Although GCS (Glasgow Coma Score) is an important predictor of outcome, it is subject to error from alcohol intoxication, sedation and intubation, and inter-rated variability.9-11 The three tier cisternal grade3 is technically simple with minimal inter observer variation. Overall it may find place not only in inter physician communications and documentation but also (as suggested by authors) in traumatic brain injury research.
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