Introduction: Traumatic brain injury (TBI) remains a significant cause of neurological morbidity and mortality. Traumatic intraparenchymal hemorrhage (tIPH) is a type of TBI that can lead to lifelong cognitive, physical, and psychological disability. Hemorrhagic progression of contusions (HPC) is a potential complication secondary to tIPH and is defined as an increase in hemorrhage volume over time.
Methods: In this retrospective study, 941 patients were admitted to our level-one trauma center with tIPH over eight years. Of these, 491 patients received admission and follow-up head computed tomography (HCT) within 72 hours. From these, the expansion rate (ER) was recorded using volumetric analysis. Effects of prehospital and in-hospital variables were examined with ordinal-response logistic regression analyses. Furthermore, these variables were examined with multivariate linear regression analysis to accurately predict the extent to which a bleed will evolve.
Results: Of the 491 patients who received admission and follow-up HCTs, 368 (74.9%) experienced HPC. On univariate analysis certain patient characteristics were significantly (p<0.05) related to HPC, including age (>60 years), GCS, blood alcohol level (BAL), international normalized ratio (INR), transfusion of platelets (PLT), anticoagulation/anti-platelet medication, tIPH volume from admission HCT, and ventriculostomy (table 1). Increased ER was significantly associated with patient disposition to hospice or death (p<0.001). Ordinal-response logistic regression identified systolic blood pressure, injury severity score (ISS), GCS, follow-up scan volume, PLT, and ventriculostomy to predict overall disposition after tICH (table 2). Multivariate linear regression identified prehospital and in-hospital variables (age, ISS, BAL, initial scan volume, epidural hematoma, subarachnoid hemorrhage, PLT, and ventriculostomy [r2=0.529]) that significantly predict HPC (table 3). The admission tICH volume proved to be the most predictive factor of HPC (r2=0.302).
Conclusions: There are various factors that contribute to the ER of tIPH over an acute period. Understanding intrinsic and modifiable variables can help predict ER and highlight potential interventions to improve TBI-associated mortality.
Patient Care: This retrospective review identifies the patient characteristics and in-hospital interventions that predict patient outcomes following traumatic intraparenchymal hemorrhage in the acute period. Understanding the relationship of intrinsic and modifiable aspects of the presenting patient that can help predict the rate of expansion and highlight potential therapeutic interventions will improve TBI-associated morbidity and mortality.
Learning Objectives: The goal of this study was:
(1) to evaluate the prognosis of traumatic intraparenchymal hemorrhage (tIPH)
(2) to develop sub-classifications of these injuries that relate to prognosis
(3) to provide a more comprehensive assessment of the hemorrhagic progression of contusions (HPC) by analyzing the rate at which tIPH blossom depending on a variety of intrinsic and modifiable factors.