Evolving Brain Lesions in the First 12 Hours after Head Injury

Servadei, Franco; Nanni, Andrea; Nasi, Maria Teresa; Zappi, D; Vergoni, G.; Giuliani, Giuliano; Arista, A.

doi:10.1097/00006123-199511000-00008

Cited by 34 publications

(37 citation statements)

References 25 publications

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“…Also, the incidence of surgical intervention was higher when the repeat CT scan followed clinical deterioration than when it was done as a routine protocol. Similar finding were reported by Yamaki et al and Servadai et al 8,22 However, it should also be recognized that there was significant proportion of patients with a CT scan done after 6 h who had to undergo surgery after the second CT. Similarly there were patients in whom a repeat CT scan done as a routine protocol without any change in neurological status led to significant changes in management, including surgery.…”

Section: Change In Management Based On Repeat Ct Scanssupporting

confidence: 88%

“…It is thus particularly important to recognize how to detect further evolution of intracranial processes of patients. 8 The initial CT scan may be followed by a second CT within 24 to 48 h for detection of evolving lesions. The need for serial CT scans and quantification of the yield of these in terms of change in the lesions seen on the first CT, development of new lesions and the role of serials CTs in influencing management requires clarification.…”

Section: Discussionmentioning

confidence: 99%

“…2,8,9,11,12,14e19 Servadei et al found that subdural hematomas were prone to re-absorption while intracerebral and extradural hematomas were more likely to increase in size or appear as new lesions. 8 EDHs were more prone to enlarge when detected within 6 h after injury. Brown et al reported that 42% of the repeat scans were unchanged, with 22% improving and 35% showing a progression of injury.…”

Section: Evolution Of Lesions On Serial Ctsmentioning

confidence: 92%

“…14 In the study by Servadei et al in addition to an increase in hematoma size in the first 12 h post injury, there was a high incidence of hematomas forming as new lesions. 8 ICH and traumatic hemorrhagic brain contusions were more prone to increase or appear as new lesions within the first 12 h. 18,22 A link between coagulopathy and the development of delayed hematomas has been shown by Stein et al 23 The fact that new intracranial lesions in the form of intracranial as well as extradural hematomas can develop following the initial lesions increases the relevance and importance of having repeat CT scans in patients with traumatic brain injury. Detection of a new lesion can have a significant impact on management decisions.…”

Section: Evolution Of Lesions On Serial Ctsmentioning

confidence: 98%

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Role of repeat CT scans in the management of traumatic brain injury

Doddamani

Gupta

Singla

et al. 2012

The Indian Journal of Neurotrauma

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Background In trauma practice, there are no guidelines on the necessity or value of repeat CT scan. The purpose of the present study was to determine the role of serial CTs in demonstrating changes in intracranial lesions and the influence on management. Methods In this study, 201 patients of traumatic brain injury were followed with serial CT scans for a maximum of up to 5 scans. The presence of different types of intracranial lesions at each CT scan as well as the evolution of lesions was recorded. The development of new lesions was noted. The management decisions at the time of each CT was detailed. Results Progression of lesion was seen most often in patients with mixed lesions (21.8%). New lesions were seen in 5.5% of patients at CT-2 and in 5.8% at CT-3. Out of total 201 patients, 47 (23%) had change in management. 26 (55%) decisions of change in management were based upon clinical deterioration and 21 (45%) upon radiological changes only. A higher incidence of surgical intervention was seen in patients who had the first CT scan within 6 h of initial trauma. However, a few patients in whom the first CT scan was 6 h after trauma as well as some patients in whom CT scan was repeated as a routine without any clinical deterioration also had a change in their management. Conclusions Repeat CT scans resulted in management changes even in patients with no clinical deterioration and thus may be of value in detecting changes at an early stage.

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Section: Change In Management Based On Repeat Ct Scanssupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Evolution Of Lesions On Serial Ctsmentioning

confidence: 92%

Section: Evolution Of Lesions On Serial Ctsmentioning

confidence: 98%

See 2 more Smart Citations

Role of repeat CT scans in the management of traumatic brain injury

Doddamani

Gupta

Singla

et al. 2012

The Indian Journal of Neurotrauma

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“…In a study by Servadei et al comprising of 37 patients, 59.5% of the patients had PHI on CT scans after 12 hours of admission and required surgical treatment. 22 In a study by Oertel et al who studied 142 patients found PHI incidence in 42.3% of the patients with the highest incidence in intraparenchymal contusions (51%) when the first computer tomography scan was performed within 2 +/-1.6 hours of injury and follow up CT scans being performed at 6.9 +/-3.6 hours. 8 Narayan et al in their prospective study reported a 50% augmentation in hemorrhagic lesions of 2ml of larger in size when CT scans were done after 24 hours of injury.…”

Section: Discussionmentioning

confidence: 98%

Incidence of progressive hemorrhagic injury in patients presenting with traumatic brain injury at a large tertiary care hospital in Karachi, Pakistan. A Case Series.

Zeeshan¹,

Kumar²,

Rehmani³

et al. 2020

TPMJ

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Objectives: Our study aims to determine the frequency of progressive hemorrhagic injury as observed on the CT scan from the initial scan performed at the time of presentation to a subsequent one in the 12 hours after the initial scan. Study Design: The type of study is a prospective observational case series. Setting: At Tertiary Care Hospital in Karachi, Pakistan. Period: 3 months from June 2018 to August 2018. Materials & Methods: All patients over 18 years of age who presented to the Accident and Emergency Department of the hospital with traumatic brain injury and had a CT scan performed within four hours of the injury were included in the study. A predesigned proforma was used to note down patient findings. CT scan findings were classified as subdural hematoma (SDH), intraparenchymal contusion (IPC) extradural hematoma (EDH) and subarachnoid hemorrhage (SAH). A repeat CT scan was performed twelve hours after the initial CT scan. Data were analyzed using IBM SPSS version 20.0, mean and frequencies were calculated for continuous variables while frequencies and percentages were calculated for categorical variables. Results: Of the n= 110 patients in our study 79 were males and 31 were female, the mean age of the patients was 34.25 years. The Glasgow Coma Scale scores at the time of arrival were between thirteen and fifteen for n= 33 (30%) of the patients, between nine and twelve for n= 54 (49.09%) of the patients, less than and equal to eight for n= 23 (20.90%) of the patients. Subarachnoid hemorrhage was present in n= 32 (29.09%) patients, intraparenchymal hematoma was present in n= 42 (38.18%) of the patients, while subdural hematoma and epidural hematoma was present in n= 14 (12.72%) and n= 22 (20%) of the patients respectively. Progressive hemorrhagic injury was found in n= 66 (60%) of the patients, while in n= 11 (10%) of the patients there was resolution of the lesion and n= 33 (33%) of the patients showed no observable changes in the repeat CT scan. Finally, our results indicate that of the 110 patients in our study PHI was seen in n= 17 (53.12%) patients with SAH, n= 18 (81.81%) patients of EDH, n= 5 (35.71%) patients of SDH and n= 26 (61.90%) patients of IPC respectively. Conclusion: According to the results of our study PHI is observed in 60% of the patients with a traumatic brain injury observed within the initial 12 hours after injury, and epidural hematoma and intraparenchymal contusions had the highest incidences of PHI among all the different types of traumatic brain injuries.

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Machine learning‐based models to predict the need for neurosurgical intervention after moderate traumatic brain injury

Habibzadeh,

Khademolhosseini,

Kouhpayeh

et al. 2023

Health Science Reports

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Background and AimsTraumatic brain injury (TBI) is a widespread global health issue with significant economic consequences. However, no existing model exists to predict the need for neurosurgical intervention in moderate TBI patients with positive initial computed tomography scans. This study determines the efficacy of machine learning (ML)‐based models in predicting the need for neurosurgical intervention.MethodsThis is a retrospective study of patients admitted to the neuro‐intensive care unit of Emtiaz Hospital, Shiraz, Iran, between January 2018 and December 2020. The most clinically important variables from patients that met our inclusion and exclusion criteria were collected and used as predictors. We developed models using multilayer perceptron, random forest, support vector machines (SVM), and logistic regression. To evaluate the models, their F1‐score, sensitivity, specificity, and accuracy were assessed using a fourfold cross‐validation method.ResultsBased on predictive models, SVM showed the highest performance in predicting the need for neurosurgical intervention, with an F1‐score of 0.83, an area under curve of 0.93, sensitivity of 0.82, specificity of 0.84, a positive predictive value of 0.83, and a negative predictive value of 0.83.ConclusionThe use of ML‐based models as decision‐making tools can be effective in predicting with high accuracy whether neurosurgery will be necessary after moderate TBIs. These models may ultimately be used as decision‐support tools to evaluate early intervention in TBI patients.

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Evolving Brain Lesions in the First 12 Hours after Head Injury

Cited by 34 publications

References 25 publications

Role of repeat CT scans in the management of traumatic brain injury

Role of repeat CT scans in the management of traumatic brain injury

Incidence of progressive hemorrhagic injury in patients presenting with traumatic brain injury at a large tertiary care hospital in Karachi, Pakistan. A Case Series.

Machine learning‐based models to predict the need for neurosurgical intervention after moderate traumatic brain injury

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