CT EVALUATION OF MIDLINE SHIFT IN TRAUMATIC BRAIN INJURY AND ITS CORRELATION WITH CLINICAL SEVERITY

Abstract

Background: Traumatic brain injury (TBI) is an important cause of morbidity and mortality and may result in a wide spectrum of neurological impairment. The Glasgow Coma Scale is commonly used to assess clinical Severity, whereas computed tomography (CT) provides rapid identification of structural intracranial abnormalities. Midline Shift (MLS) is an important CT finding associated with intracranial mass effect. This study evaluates the relationship between CT-measured MLS and Clinical severity in patients with traumatic brain injury.

Methods: A cross-sectional study was conducted among 40 patients with traumatic brain injury presenting to tertiary-care hospitals in Multan. We assessed clinical severity using the Glasgow Coma Scale and categorized it as mild (13-15), moderate (9-12), or severe (<8). All patients had a non-contrast CT scan. We measured midline shift in millimeters on axial CT images at the level of the third ventricle or septum pellucidum using standardized anatomical landmarks. Data were analyzed using SPSS version 26. We used descriptive statistics, chi-square tests, and Spearman’s rank correlation coefficient. A p-value <0.05 was considered statistically significant.

Results: Of the 40 patients, 13 (32.5%) were female, and 27 (67.5%) were male. Twenty-three  (57.5%) of the patients had mild TBI, six (15.0%) had moderate TBI, and eleven (27.5%) had severe TBI. Twenty -one (52.5%) patients had no MLS, while 19 (47.5%) exhibited midline shift. Eleven (57.9%) of the MLS patients had severe traumatic brain injury (TBI), six (31.6%) had moderate TBI, and two (10.5%) had mild TBI. On the other hand, mild TBI was present in all 21 patients who did not have MLS. The presence of MLS and the severity of TBI were found to be statistically correlated (χ² = 32.677, df = 2, p < 0.001). The degree of MLS and the severity of TBI were found to be strongly positively correlated by Spearman's correlation (ρ = 0.859, p < 0.001).

Conclusion: In patients with traumatic brain injury, CT-detected midline shift was highly correlated with clinical severity. A higher degree of MLS was linked to a more severe TBI. Therefore, when assessing patients with traumatic brain injury, systematic evaluation of MLS on CT may offer helpful objective radiological information.