What are the strongest indicators of intracerebral hemorrhage in mild traumatic brain injury?

Abstract

BackgroundAlthough there are eight factors known to indicate a high risk of intracranial hemorrhage (ICH) in mild traumatic brain injury (TBI), identification of the strongest of these factors may optimize the utility of brain CT in clinical practice. This study aimed to evaluate the predictors of ICH based on baseline characteristics/mode of injury, indications for brain CT, and a combination of both to determine the strongest indicator.MethodsThis was a descriptive, retrospective, analytical study. The inclusion criteria were diagnosis of mild TBI, high risk of ICH, and having undergone a CT scan of the brain. The outcome of the study was any type of ICH. Stepwise logistic regression analysis was used to find the strongest predictors according to three models: (1) injury pattern and baseline characteristics, (2) indications for CT scan of the brain, and (3) a combination of models 1 and 2.ResultsThere were 100 patients determined to be at risk of ICH based on indications for CT of the brain in patients with acute head injury. Of these, 24 (24.00%) had ICH. Model 1 found that injury due to motor vehicle crash was a significant predictor of ICH, with an adjusted OR (95% CI) of 11.53 (3.05 to 43.58). Models 2 and 3 showed Glasgow Coma Scale (GCS) score of 13 to 14 after 2 hours of observation and open skull or base of skull fracture to be independent predictors, with adjusted OR (95% CI) of 11.77 (1.32 to 104.96) and 5.88 (1.08 to 31.99) according to model 2.DiscussionOpen skull or base of skull fracture and GCS score of 13 to 14 after 2 hours of observation were the two strongest predictors of ICH in mild TBI.Level of evidenceIII.

Indicators of abnormal CT Scan findings in clinically mild traumatic brain injury patients

“…Traffic injury-related factors such as the type of vehicle used (car, motorbike, bicycle, or pedestrian) and whether the patient was a passenger or driver were also included in the analysis, but none of these factors was statistically significant. 15 A more detailed analysis of several factors related to injury mechanisms, including the presence of dangerous injury mechanism features, was not carried out in this study due to limited data.…”

“…9,10 Furthermore, performing CT scans increases the exposure to X-rays and the financial burden on the patient. 5,7,8,13,15,16 Several guidelines assist in prescribing CT scans for patients with MTBI. [14][15][16] However, the proper and efficient implementation of this remains challenging in small healthcare centers.…”

“…5,7,8,13,15,16 Several guidelines assist in prescribing CT scans for patients with MTBI. [14][15][16] However, the proper and efficient implementation of this remains challenging in small healthcare centers. 11 Therefore, this study aims to identify various indicators that can predict abnormal CT scan findings in clinically MTBI patients.…”

Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department

“…Risk factors for poor prognoses in TBI have been extensively studied [25,26], and many of them have been incorporated into clinical decision rules (CDRs) [25,[27][28][29][30], which, undoubtedly, are tools of outstanding importance for clinicians practicing in any ED, particularly in the case of mTBI. For example, CDRs assist the clinician in identifying patients who have essentially no risk of significant ICI after mTBI and for whom a CT scan is therefore unnecessary [25,31].…”

“…Evidence about indications for neurosurgery after TBI in patients on OAT is scarce and inconsistent, hampering the formulation of reliable recommendations for clinical practice. Regardless of the use of anticoagulants, the NICE GL recommends discussing together with a neurosurgeon the care of patients with significant neuroimaging alterations, persisting coma after initial resuscitation, unexplained confusion that persists for more than 4 h, deterioration in GCS score after admission, progressive focal neurological signs, seizures without full recovery, definite or suspected penetrating injuries, and cerebrospinal fluid leak [26]. The last Brain Trauma Foundation GL for the management of sTBI [97] provided recommendations about decompressive craniectomy and cerebrospinal fluid drainage, but no specific considerations for patients on OAT.…”