Predicting Progressive Hemorrhagic Injury after Traumatic Brain Injury: Derivation and Validation of a Risk Score Based on Admission Characteristics

Abstract

Previous studies have demonstrated that patients with traumatic brain injury (TBI) who also have progressive hemorrhagic injury (PHI), have a higher risk of clinical deterioration and worse outcomes than do TBI patients without PHI. Therefore, the early prediction of PHI occurrence is useful to evaluate the status of patients with TBI and to improve outcomes. The objective of this study was to develop and validate a prognostic model that uses information available at admission to determine the likelihood of PHI after TBI. Retrospectively collected data were used to develop a PHI prognostic model with a logistic regression analysis. The prediction model was validated in 114 patients from a separate hospital. Eight independent prognostic factors were identified: age ‡ 57 years (5 points), intra-axial bleeding/brain contusion (4 points), midline shift ‡ 5 mm (6 points), platelet (PLT) count < 100 · 10 9 /L (10 points), PLT count ‡ 100 but < 150 · 10 9 /L (4 points), prothrombin time > 14 sec (7 points), D-dimer ‡ 5 mg/L (12 points), and glucose ‡ 10 mmol/L (10 points). Each patient was assigned a number of points proportional to the regression coefficient. We calculated risk scores for each patient and defined three risk groups: low risk (0-13 points), intermediate risk (14-22 points), and high risk (23-54 points). In the development cohort, the PHI rates after TBI for these three groups were 10.3%, 47.3%, and 85.2%, respectively. In the validation cohort, the corresponding PHI rates were 10.9%, 47.3%, and 86.9%. The C-statistic for the point system was 0.864 ( p = 0.509 by the Hosmer-Lemeshow test) in the development cohort, and 0.862 ( p = 0.589 by the Hosmer-Lemeshow test) in the validation cohort. In conclusion, a relatively simple risk score using admission predictors accurately predicted the risk for PHI after TBI.

Derivation of a Predictive Score for Hemorrhagic Progression of Cerebral Contusions in Moderate and Severe Traumatic Brain Injury

“…Prior reports have identified that radiographic factors such as the presence of a subdural hematoma (SDH) [4, 6, 12], subarachnoid hemorrhage (SAH) [4, 5, 7], and larger contusion volume [5, 6, 10] are associated with higher risk for HPC, as well as clinical factors such as older age [4, 13], hyperglycemia [14], antiplatelet medication use [15], low platelet count [16], and timing of the initial CT scan [4, 7]. One prior group attempted to develop a predictive score using clinical parameters [14]; but the lowest risk patient group still had a high incidence of HPC (10.3 %) in this study, and the algorithm was complex.…”

“…One prior group attempted to develop a predictive score using clinical parameters [14]; but the lowest risk patient group still had a high incidence of HPC (10.3 %) in this study, and the algorithm was complex.…”

A meta-analysis to determine the effect of coagulopathy on intracranial haematoma progression in adult patients with isolated blunt head trauma

“…Significant heterogeneity was present in this meta-analysis due to several factors. 11 Prospective observation study GCS <13 and positive head CT scan Joseph et al 12 Retrospective cohort Any GCS level and positive head CT scan Juratli et al 13 Prospective observation study Any GCS level and positive head CT scan Yuan et al 14 Retrospective cohort Any GCS level and positive head CT scan Allard et al 15 Subgroup post hoc analysis of RCT for hypertonic resuscitation for TBI GCS 8 positive head CT scan White et al 16 Prospective cohort Any GCS level and positive head CT scan Yadav et al 17 Prospective cohort Any GCS level and positive head CT scan Kaups et al 18 Retrospective cohort Severe TBI (AIS > 3) Sanus et al 19 Retrospective cohort Any GCS level and positive head CT scan Oertel et al 20 Retrospective cohort Any GCS level and positive head CT scan Stein et al 21 Retrospective cohort GCS < 13 Stein et al 22 Retrospective cohort GCS < 13 TBI, traumatic brain injury; GCS, Glasgow Coma Score; CT, computed tomography; RCT, randomised control trial. There was some variation in the size of the studies (range 46-540); however, the meta-analysis was not heavily weighted by one particular study.…”

6 postoperative imaging of TBIPostoperative Imaging of Traumatic Brain Injury

“…This is especially true after surgical intervention for another ICH, where surgical decompression can reduce adja cent mass effect (and associated tamponade of hemorrhage), allowing a parenchymal contusion to enlarge or "blossom" Some patients are more susceptible to rebleeding, also called progressive hemorrhagic injury (PHI), and these patients may warrant closer postoperative monitoring or imaging. 13 A list of risk factors for rebleeding/PHI follows:…”