Introduction: Patients with Traumatic Brain Injury (TBI) can suffer from various classes of TBI that consist of one or many subtypes of TBI (i.e., tSAH, SDH, EDH, and IPH). We sought to understand if the frequency of co-occurring TBI subtypes is related to intracranial compartmental distance, and if any relationship exists between compartmental distances and short-term outcome.
Methods: We used the trauma registry database to retrospectively identify all patients admitted to a level-1 trauma center during the 11-year period. We categorized patients into various classes of TBI depending on the subtypes of TBI acquired. The percentage of patients who acquired two co-occurring TBI subtypes (e.g., tSAH+SDH) in any class was expressed over the product of the percentages of each all-inclusive subtype (e.g., the product of the percentage of all-inclusive tSAH and the percentage of all-inclusive SDH in the TBI population).
Results: We found a total of 1,716 TBI patients without major systemic injuries. We found that with each class of co-occurring TBI subtypes, these injuries were less likely to co-occur than their predicted frequencies. Co-occurring tSAH and SDH had the highest ratio of actual to expected frequency (0.56), and co-occurring IPH and EDH had the lowest ratio (0.19). When we graphed the ratios of actual to expected frequencies of these co-occurring TBI subtypes according to compartmental distance, we found an indirect relationship between ratio of actual to expected frequencies and the compartmental distance. When we analyzed post-hospital disposition according to compartmental distance, we found no statistically significant trends in post-hospital disposition.
Conclusions: The incidence of different TBI subtypes co-occurring arises less likely than expected, and there exists an indirect relationship between the frequency of co-occurring TBI subtypes and their intracranial compartmental distances.
Patient Care: Understanding patterns of radiographic findings of various intracranial hemorrhages and their likelihood of having co-occurring TBI subtypes will aid in the triage and overall management of these patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the relationship between the co-occurrence of TBI subtypes and intracranial compartmental distance, and 2) Understand the likelihood of co-occurring TBI subtypes based on isolated injuries.