Rate of Intracranial Hemorrhage After Minor Head Injury

Abstract

Introduction: Computed tomography scans of the head (CTH) are an important component of the initial patient evaluation after blunt head trauma in select patients. Here we review findings of CTH performed for mild traumatic brain injury (TBI) at a Level I trauma center over a two-year period. We subsequently discuss the role and limitations of published clinical decision rules aiming to decrease unnecessary CTH in mild TBI patients. Methods: We reviewed all Emergency Department CTH obtained after blunt head trauma between 2010 and 2011. Patient demographics and radiology report texts were collected. Reports were cross-referenced with our institutional trauma database to obtain initial Glasgow Coma Scale (GCS). Mild TBI was defined by an initial GCS 13-15 with or without loss of consciousness or post-traumatic amnesia. Results: There were 5,634 mild TBI patients evaluated with CTH. A total of 477 scans (8.5%) were positive for intracranial hemorrhage. Of these, 188 (39.4%) showed more than one type of intracranial hemorrhage. The most common findings were subdural hematomas (262, 4.7% of scans), traumatic subarachnoid hemorrhages (252, 4.5% of scans), and cerebral contusions/intraparenchymal hematomas (212, 3.8% of scans). Older age (p<0.001) and male gender (p<0.001) were associated with positive CTH. Conclusions: The rate of positive CTH in mild TBI patients in our population falls within a historical range. The clinical and medicolegal implications of missed intracranial hemorrhage have remained important factors limiting the implementation of clinical decision rules in screening mild TBI patients for CTH.

Head Injury and Intracranial Hemorrhages: A CT Imaging Study of Trauma Patients

“…A study by Roghani and Ali showed 3% SAH, 10% SH, and 10% EH (10). A study conducted by Bonney et al in 2020 showed that the most common findings of intracranial hemorrhages were 4.7% for subdural hemorrhage, 4.5% for traumatic subarachnoid hemorrhage, and 3.8% for intraparenchymal hemorrhage (14). However, the current study revealed that subdural hemorrhage accounted for 36% of all intracranial hemorrhages, followed by epidural hemorrhages (28%), subarachnoid hemorrhages (20%), and intraparenchymal hemorrhages (16%).…”

“…Additionally, unrecognized intracranial hematoma continues to have significant clinical and legal ramifications for emergency medicine practitioners (12). This last factor is likely responsible for the growing use of CTH because no decision tool has ever demonstrated 100% sensitivity across a population tested (14).…”

Modified mouse model of repeated mild traumatic brain injury through a thinned‐skull window and fluid percussion

“…Moreover, the hematomas vanished and the microvasculature morphology remodeled within 48 h, indicating a microvascular recovery process (Lin et al, 2022). Two recent reviews showed that 12.9%–17.3% of mTBI patients suffer intracranial hemorrhage (Bonney et al, 2020; Isokuortti et al, 2018). Relative to those with a single mTBI, rmTBI demonstrates an increased prevalence of cerebral microhemorrhages in football players (Slobounov et al, 2017).…”

Radiological features of brain hemorrhage through automated segmentation from computed tomography in stroke and traumatic brain injury

“…Several other studies have reported on hemorrhage detection using CT scans ( 9 , 19 ) and these efforts used considerably larger sample sizes than the external CT cases for the current VIOLA-AI tool. It is intriguing that the VIOLA-AI tool achieved adequate classification performance for all samples, but the scores decreased when considering the low yield cases of consecutive mild TBI cases ( 29 ). This suggests that VIOLA-AI is currently better suited for ICH and confirmed TBI-bleeds rather than as a detection tool for mild TBI sites.…”