Midline Shift as a Predictor of Outcome in Head Trauma Patients managed Conservatively

Abstract

Objective:  To evaluate the role of the degree of midline shift on CT scans in predicting clinical outcomes in traumatic brain injury (TBI). Materials and Methods:  A prospective observational study was conducted at the Department of Neurosurgery of a tertiary care hospital. We included 148 patients. After fulfilling the inclusion criteria, the patient’s baseline data, including the patient's age, gender, and CT scan findings with the degree of midline shift, was noted. The patients were monitored for three months to evaluate the outcome. The collected data was analyzed using SPSS version 22.0. Results:  Our study showed that 105 (70.9%) patients showed satisfactory outcomes while 43 (29.1%) showed unsatisfactory outcomes. Patients with no midline shift were 70, out of which 55 (78.6%) showed satisfactory outcomes. Similarly, patients with 1-2 mm midline shifts showed satisfactory outcomes in 39 (69.6%) while 3-5 mm midline shifts showed 11 (50%) satisfactory outcomes. In our study, the degree of brain midline shift on CT scan was a statistically significant outcome factor (p = 0.035). Conclusion:  Patients with TBI who had an increasing degree of midline shift on brain CT scans had considerably worse clinical outcomes. Keywords:  Midline shift, CT scan, Glasgow Coma Score, Head Injury.