Abstract
Introduction
Community centers commonly transfer patients with traumatic intracranial hemorrhage
(ICH) to level 1 and 2 trauma centers for neurosurgical evaluation regardless of the
degree of injury. Determining risk factors leading to neurosurgical intervention (NSI)
may reduce morbidity and mortality of traumatic ICH and the transfer of patients with
lower risk of NSI.
Methods
A retrospective chart review was performed on patients admitted or transferred to
a level 1 trauma center from October 2015 to September 2019 with Glassgow Coma Scale
score 13-15 and traumatic ICH on initial head computerized tomography (CTH) scan.
Bivariate analyses and multivariable regression were used to identify factors associated
with progression to NSI.
Results
Of 1542 included patients, 8.2% required NSI. A greater proportion were male (69.1%
versus 52.3%, P = 0.0003), on warfarin (37.7% versus 21.6%, P = 0.0023), presented with subdural hemorrhage (98.4% versus 63.3%, P < 0.0001, larger subdural hemorrhage size (median 19 mm [interquartile range {IQR}:
14-25] versus 5 mm [IQR: 3-8], P < 0.0001), and had a worsening repeat CTH (24.4% versus 13%, P < 0.0001). On physical examination, more patients had confusion (40.5% versus 31.4%, P = 0.0495) and hemiparesis (16.2% versus 2.6%, P < 0.0001). CTH findings of midline shift (80.2% versus 10.8%, P < 0.0001) and shift size (median 8.0 mm [IQR: 5.0-12.0] versus 4 mm [IQR: 3-5], P < 0.0001) were significantly associated with NSI.
Conclusions
Clinical factors and patient characteristics can be used to infer a greater risk of
requiring NSI. These factors could reduce unnecessary transfers and hasten the transfer
of patients more likely to progress to NSI.
Keywords
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Article info
Publication history
Published online: November 17, 2022
Accepted:
October 19,
2022
Received in revised form:
September 16,
2022
Received:
February 28,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
