The profile of blunt traumatic supratentorial cranial bleed types

Abstract

The characteristics of blunt traumatic supratentorial cranial bleed (STCB) types have not been directly compared. The National Trauma Data Bank (NTDB) 2014 was queried for adults with an isolated single STCB n=57,278. Patients were grouped by STCB categories: subdural (SDH), subarachnoid (SAH), epidural (EDH), intraparenchymal (IPH), and intraventricular hemorrhage (IVH). Frequency, demographics, clinical characteristics, procedures, and outcomes were compared among groups. SDH was the most common STCB (53%) and occurred mostly in elderly patients after a fall (78%), 30% underwent craniotomy and their mortality was 7%. SAH occurred in 32% of patients and carried the lowest mortality (3%). SAH were least likely to have a severe brain injury (7%), and had the lowest Injury Severity Score (ISS, median 8) and complication rate (1%), as well as the shortest hospital length of stay (HLOS, 4.6 ± 6.4 days). EDH was uncommon (2%), occurred in younger patients (median 35 years), and had the highest percentage of traffic related injuries (28%). While EDH patients presented with the poorest neurological status (16% Glasgow Coma Scale ≤8, ISS median 18) and were operated on more than any other STCB type (51%), their mortality was lower (4%) and they had the highest discharge to home rate (71%). IVH was the least common (2%), but most lethal (9%) STCB type. These patients had the highest HLOS and intensive care unit LOS, and the lowest craniotomy rate (21%). STCB types have different clinical course, and outcomes. Understanding these differences can be useful in managing patients with STB.

Educational Case: Cranial hemorrhage and traumatic brain injury

“…Epidural hematomas tend to present in a younger population of patients, with a median age of 35 years. 5 This is younger than the population age associated with other types of intracranial hemorrhages due to trauma. Multiple factors likely contribute to this population shift, including less adherent dural attachments in this younger age group and increased high risk-taking behavior resulting in an increased rate of motor vehicle accidents and falls from great heights.…”

“…4 The temporal bone overlies the middle meningeal artery, and fractures to this bone commonly cross the course of the vessel, disrupting the integrity of the vessel and causing a bleed. 5 Epidural hematomas are arterial bleeds with arterial pressure behind them. This pressure causes the outer layer of the dura mater, the endosteal layer, which is normally fused to the internal surface of the skull, to separate from the skull.…”

“…Due to the force required to fracture the temporal bone, epidural hematomas are more often associated with high-energy mechanisms of injury, such as motor vehicle accidents and severe blows to the head, as opposed to other types of cranial hemorrhages. 5 …”

“…Multiple factors likely contribute to this population shift, including less adherent dural attachments in this younger age group and increased high risk-taking behavior resulting in an increased rate of motor vehicle accidents and falls from great heights. 5 …”

“…4 Despite initial presentation, epidural hematoma has the second-lowest mortality and a higher percentage of patients making a full recovery as compared to other types of trauma-induced cranial hemorrhage. 5 …”