Risk Factors and Outcomes of Progressive Intracranial Hemorrhage after Traumatic Head Injury

Kang, Ji Hoon; Han, Yong Pyo; Hong, Soon Ki; Hu, Chul; Pyen, Jhin Soo; Whang, Kum

Abstract

OBJECTIVES
The purpose of this study is to find a better solution to treatment of patients with head trauma by analyzing the clinical progress and factors related to progressive intracranial hemorrhage (PIH) through comparisons between initial and follow up brain CT.
METHODS
Of all acute head trauma patients admitted from November, 2003 to November 2005, 122 patients with EDH, SDH, ICH, and SAH seen on initial brain CT were selected. We retrospectively assessed brain CT and clinical data of all the patients, and sex, age, initial GCS, interval from initial injury to initial brain CT, interval from initial CT to follow CT, presence of skull fractures, GOS scores, and CT image findings were analyzed. We divided these patients into the two groups; patients with increased hemorrhage on follow up brain CT, and those without any interval change. Possible initiating factors and prognosis were analyzed in both groups.
RESULTS
Of the 122 patients, 48 patients showed increased hemorrhage on follow up CT (39.3%), and 74 patients did not (60.7%). The mean age of patients with increased hemorrhage was 49 yrs. 31 patients were male, and 17 patients were female in the increased hemorrhage group. The increased hemorrhage group had an older mean age and a higher ratio of male patients (p<0.05, p<0.05). In the increased hemorrhage group, the type of hemorrhage were as follows: 16 patients with an ICH, 12 patients with a SDH, 11 patients with an EDH, and 9 patients with a traumatic SAH. The average interval between initial trauma and initial brain CT was 3.8±0.62 hrs in the increased hemorrhage group, and 5.3±1.24 hrs in the no interval change group. Average interval between initial and follow up brain CT was 13.4±2.41 hrs in the increased hemorrhage group, and 23.48±0.95 hrs in the no interval change group. Patients with increased hemorrhage showed a shorter interval between all studies, but only the interval between the initial and follow up brain CT showed a statistical significant correlation (p>0.05, p<0.05). Initial GCS, presence of skull fractures, and hemorrhage lesion did not show a significant difference between the two groups.
CONCLUSION
The patients age, sex, increased PT (INR) were risk factors of PIH, and the interval between initial and follow up brain CT were shorter in these cases. Therefore early brain CT follow up can help identify and adequately treat patients with PIH.