• M J Chavero-Magro, R Rivera-Fernández, H Busquier-Hernández, E Fernández-Mondéjar, F Pino-Sánchez, R Díaz-Contreras, F J Martín-López, and R Domínguez-Jiménez.
• Unidad de Cuidados Intensivos, Hospital Virgen del Puerto, Plasencia, Cáceres, Spain.
• Med Intensiva. 2007 Aug 1; 31 (6): 281-8.

ObjectiveTo determine whether the usual mortality prediction systems (APACHE and SAPS) can be complemented by cranial computed tomography (CT) brain herniation findings in patients with structural neurological involvement.DesignProspective cohort study.SettingTrauma ICU in university hospital.PatientsOne hundred and fifty five patients admitted to ICU in 2003 with cranial trauma or acute stroke.Main Variables Of InterestData were collected on age, diagnosis, mortality, admission cranial CT findings and on APACHE II, APACHE III and SAPS II scores.ResultsMean age was 47.8 +/- 19.4 years; APACHE II, 17.1 +/- 7.2 points; SAPS II, 43.7 +/- 17.7 points; and APACHE III, 55.8 +/- 29.7 points. Hospital mortality was 36% and mortality predicted by SAPS II was 38%, by APACHE II 30% and by APACHE III 36%. The 56 non-survivors showed greater midline shift on cranial CT scan versus survivors (4.2 +/- 5.5 vs. 1.6 +/- 3.22 mm, p = 0.002) and higher severity as assessed by SAPS II, APACHE II and APACHE III. The mortality rate was significantly higher in patients with subfalcial herniation (61% vs. 30%, p < 0.001). In the multivariate logistic regression analysis, hospital mortality was associated with the likelihood of death according to APACHE III (OR 1.07; 95% CI: 1.05-1.09) and with presence of subfalcial herniation (OR 3.15; 95% CI: 1.07-9.25).ConclusionsIn critical care patients with structural neurological involvement, cranial CT signs of subfalcial herniation complement the prognostic information given by the usual severity indexes.

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