• S P Choi, H K Park, K N Park, Y M Kim, K J Ahn, K H Choi, W J Lee, and S K Jeong.
• Department of Emergency Medicine, St Mary's Hospital, 62 Yeouido-dong, Yeongdeungpo-gu, Seoul, Korea.
• Emerg Med J. 2008 Oct 1;25(10):666-9.

ObjectivesTo evaluate whether the ratio (in Hounsfield units; HU) of grey matter (GM) to white matter (WM) on computed tomography (CT) scans taken within 24 h of resuscitation can be used as a predictor of outcome.Methods28 patients who resuscitated from cardiac arrest and had head CT performed within 24 h of resuscitation were retrospectively investigated. 27 subjects with normal head CT findings served as controls. Comatose patients were divided into two groups: those with a Glasgow outcome scale (GOS) score of 3-5 (good outcome subgroup) and those with a GOS score of 1-2 (poor outcome subgroup). HU were measured in GM and WM at the level of the basal ganglia on non-contrast CT scans.ResultsThe density ratio of GM to WM was significantly lower in comatose patients than in controls (mean 1.21 vs 1.32, p<0.001). The GM:WM ratio was significantly lower in the poor subgroup than in the good subgroup (mean 1.19 vs 1.28, p<0.001). Receiver operating characteristic curve analysis determined a cutoff value of a GM:WM ratio of less than 1.22 for vegetative state or death. This value predicted vegetative state or death with a sensitivity of 63%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 56%.ConclusionThe GM/WM ratio correlates with the outcome of hypoxic ischaemic encephalopathy and may be useful as an objective early predictor of vegetative state or death in comatose patients after cardiac arrest.

22 keywords...

hide…