Introduction: Annually in the US, an estimated 1.7 million people experience traumatic brain injury (TBI), resulting in 1.4 million ED visits, 270,000 hospitalizations, and 53,000 deaths. The most common mass lesions associated with TBI are hematomas and contusions. Currently, there is no proven treatment protocol for contusion management. This retrospective study seeks to provide a more comprehensive assessment of the hemorrhagic progressions of contusions (HPC) by analyzing the rate at which contusions blossom depending on a variety of factors.
Methods: This retrospective study examined 492 patients with cerebral contusions from 2005-2013, who presented to a level 1 trauma center and had follow-up computed tomography (CT) < 72 hours later. Change in contusion volume over time, expansion rate (ER), was recorded for all patients.
Results: Of the 492 patients, 73.6% experienced HPC with an average ER of 0.73 cm3/hr. Patients were compared based on blood alcohol level (BAL) (n=152; 30.4%), platelet transfusion (n=47; 9.4%), and anticoagulation therapy (n=36; 7.2%). Separate one-way ANCOVAs revealed significant differences in mean ER for patients with elevated BAL (p=0.032), transfused platelets (p < 0.001), and anticoagulation (p=0.0072). A multiple regression analysis revealed that age (p=0.03), systolic blood pressure (p=0.005), INR (b=1.003, t=2.76, p=0.007), new injury severity score (b=0.02, t=2.10, p=0.03), BAL (b=0.003, t=2.10, p=0.03), and initial size of contusion (b=-0.049, t=-2.65, p=0.009) significantly predicted 35.9% of the variance in ER (p<0.001). Sex and GCS were non-significant predictors of expansion.
Conclusions: There are various factors that contribute to the rate at which cerebral contusions blossom over an acute time course. Understanding the relationship of intrinsic and modifiable aspects of the presenting patient can help predict the rate of expansion and highlight potential therapeutic interventions to improve TBI associated mortality.
Patient Care: Our research seeks to understand the relationship of intrinsic and modifiable factors of a presenting TBI patient that cause varying degrees of hemorrhagic expansion. The ability to predict the rate of expansion will improve the care of TBI patients and highlight potential therapeutic interventions to improve TBI associated mortality.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand the significance of cerebral contusions on traumatic brain injury; 2) Identify key factors that contribute to the hemorrhagic progression of cerebral contusions; and 3) Discuss the ability to predict the extend to which TBI bleeds expand.