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J Med Assoc Thai. 2010 Jan;93(1):99-107.

Degree of midline shift from CT scan predicted outcome in patients with head injuries.

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  • 1Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.



To evaluate the relationship between the degree of midline shift by Computed Tomography (CT) finding and Glasglow Coma Score (GCS) as a predictive of clinical outcome in patients after head injury. METHOD AND METHOD: The present study was performed by retrospectively reviewing 216 consecutive cases of traumatic head injury admitted to the trauma center in Siriraj Hospital from 1999 until 2004. All patients were evaluated for level of consciousness by a neurosurgeon determining by GCS and underwent CT brain for evaluation of intracranial hemorrhage and midline shift. The final clinical outcome was also divided into two groups; good outcome for the patients who recovered well with moderate disability and the poor outcome for the patients who suffered severe disability, vegetative status and death. Then, the authors compared midline shift vs. GCS and midline shift vs. clinical outcomes.


Total of 216 cases, the three most common types of head injury were motorcycle accident, fall or assault and car accident. 96 of 216 patients had midline shifting, 53 of 96 patients had CT scan of midline shifting less than 10 mm whereas 37 of 96 patients had a CT scan of greater than 10 mm of midline shifting. 63.3% with midline shifting up to 10 mm had severe head injury and up to 81% with brain shifting greater than 10 mm had severe head injury. The clinical outcome also showed that poor clinical outcomes correlated to midline shifting greater than 10 mm.


The increased degree of midline shift in patients with head injuries by CT scan was related to the severity of head injury (GCS = 3-12) and was significantly related to poor final clinical outcome.

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