Risk factors for delayed neuro-surgical intervention in patients with acute mild traumatic brain injury and intracranial hemorrhage

BackgroundMild traumatic brain injury (TBI) patients with initial traumatic intracranial hemorrhage (tICH) and without immediate neuro-surgical intervention require close monitoring of their neurologic status. Progressive hemorrhage and neurologic deterioration may need delayed neuro-surgical intervention. This study aimed to determine the potential risk factors of delayed neuro-surgical intervention in mild TBI patients with tICH on admission.MethodsThree hundred and forty patients with mild TBI and tICH who did not need immediate neuro-surgical intervention on admission were evaluated retrospectively. Their demographic information, clinical evaluation, laboratory data, and brain CT was reviewed. Delayed neuro-surgical intervention was defined as failure of non-operative management after initial evaluation. Risk factors of delayed neuro-surgical intervention on admission were analyzed.ResultsDelayed neuro-surgical intervention in mild TBI with tICH on initial brain CT accounted for 3.8 % (13/340) of all episodes. Higher WBC concentration, higher initial ISS, epidural hemorrhage (EDH), higher volume of EDH, midline shift, and skull fracture were risk factors of delayed neuro-surgical intervention. The volume of EDH and skull fracture is independent risk factors. One cubic centimeter (cm3) increase in EDH on initial brain CT increased the risk of delayed neurosurgical intervention by 16 % (p = 0.011; OR: 1.190, 95 % CI:1.041–1.362).ConclusionsMild TBI patients with larger volume of EDH have higher risk of delayed neuro-surgical interventions after neurosurgeon assessment. Longer and closer neurological function monitor and repeated brain image is required for those patients had initial larger EDH. A large-scale, multi-centric trial with a bigger study population should be performed to validate the findings.

• Publication year

  2016

• Venue

  World Journal of Emergency Surgery

• Publication date

  2016-03-31

• Fields of study

  Medicine

• Identifiers
  DOI 10.1186/s13017-016-0069-2PMID 27034712PMCID 4815160
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Utility of routine follow-up head CT scanning after mild traumatic brain injury: a systematic review of the literature

  2012cited by this paper
• Progressive Epidural Hematoma in Patients with Head Trauma: Incidence, Outcome, and Risk Factors

  2012cited by this paper
• Are routine repeat imaging and intensive care unit admission necessary in mild traumatic brain injury?

  2012cited by this paper
• Identification of low-risk patients with traumatic brain injury and intracranial hemorrhage who do not need intensive care unit admission.

  2011cited by this paper
• Scheduled repeat CT scanning for traumatic brain injury remains important in assessing head injury progression.

  2010cited by this paper
• The clinical efficacy of repeat brain computed tomography in patients with traumatic intracranial haemorrhage within 24 hours after blunt head injury

  2009cited by this paper
• Predictive value of leucocytosis in head trauma.

  2009cited by this paper
• Necessity of repeat head CT and ICU monitoring in patients with minimal brain injury.

  2009cited by this paper
• Routine serial computed tomographic scans in mild traumatic brain injury: when are they cost-effective?

  2008cited by this paper
• Traumatic Delayed Epidural Hematoma

  2006cited by this paper
• Surgical management of acute epidural hematomas.

  2006cited by this paper
• A prospective evaluation of the value of repeat cranial computed tomography in patients with minimal head injury and an intracranial bleed.

  2006cited by this paper
• Epidemiology of blunt head injury victims undergoing ED cranial computed tomographic scanning.

  2006cited by this paper
• Routine repeat head CT for minimal head injury is unnecessary.

  2006cited by this paper
• Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients.

  2005cited by this paper
• Value of repeat cranial computed axial tomography scanning in patients with minimal head injury.

  2004cited by this paper
• Coagulopathy as a parameter to predict the outcome in head injury patients--analysis of 61 cases.

  2004cited by this paper
• Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury.

  2002cited by this paper
• CT scan findings in mild head trauma: a series of 2,000 patients.

  2002cited by this paper
• The blood leukocyte count and its prognostic significance in severe head injury.

  2001cited by this paper
• Indications for computed tomography in patients with minor head injury.

  2000cited by this paper
• INDICATIONS FOR COMPUTED TOMOGRAPHY IN PATIENTS WITH MINOR HEAD INJURY

  2000cited by this paper
• Traumatic brain injury: patterns of failure of nonoperative management.

  1999cited by this paper
• Role of coagulopathy in patients with head trauma.

  1998cited by this paper
• The expectant treatment of "asymptomatic" supratentorial epidural hematomas.

  1993cited by this paper
• Delayed epidural hematoma without neurologic deficit.

  1990cited by this paper
• The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.

  1974influential reference

• Effect of very early (<24 hours) pharmacological thromboprophylaxis on clinical outcome in patients with traumatic intracranial haemorrhage: a systematic review and meta-analysis.

  2025cites this paper
• Guiding lights in the early postoperative computed tomography following cranial surgery for traumatic brain injury patients

  2024cites this paper
• Prognostic Factors of Recovery and Discharge Outcome in Adults after Moderate Traumatic Brain Injury

  2024cites this paper
• The Correlation Between CT Findings and Neurosurgical Intervention in Mild Traumatic Brain Injury Patients with Isolated Subdural Hematomas

  2024cites this paper
• Development of predictive model for the neurological deterioration among mild traumatic brain injury patients using machine learning algorithms

  2024cites this paper
• Nuance and profound impact: Evaluating the effects of the unmet full coma scale in patients with mild subdural hemorrhage.

  2023cites this paper
• Endoscopic-assisted removal of bilateral traumatic intracerebral hemorrhage: A case report

  2023cites this paper
• Predictive Factors for Delayed Surgical Intervention in Children With Epidural Hematomas

  2022cites this paper
• The unmet global burden of cranial epidural hematomas: A systematic review and meta-analysis.

  2022cites this paper
• Neurological deteriorations in mild brain injuries: the strategy of evaluation and management

  2021cites this paper
• Surgical application of endoscopic-assisted minimally-invasive neurosurgery to traumatic brain injury: Case series and review of literature.

  2021cites this paper
• Recalibrating the Glasgow Coma Score as an Age-Adjusted Risk Metric for Neurosurgical Intervention.

  2021cites this paper
• To determine the outcome of isolated hemorrhagic TBI in a large tertiary care center in Karachi, Pakistan.

  2021cites this paper
• Retention of neutralizing antibodies to Japanese encephalitis vaccine in age groups above fifteen years in Korea.

  2020cites this paper
• Biomarkers May Predict Unfavorable Neurological Outcome after Mild Traumatic Brain Injury

  2020cites this paper
• Isolated subdural hematomas in mild traumatic brain injury. Part 2: a preliminary clinical decision support tool for neurosurgical intervention.

  2019cites this paper
• Neurosurgical Outcomes of Isolated Hemorrhagic Mild Traumatic Brain Injury

  2019cites this paper
• Guidelines for the emergency department management of traumatic brain injury : an impact assessment and development of a prognostic model to inform hospital admission decisions

  2019cites this paper
• Isolated subdural hematomas in mild traumatic brain injury. Part 1: the association between radiographic characteristics and neurosurgical intervention.

  2019cites this paper
• Strategic Applications of Business Analytics to Healthcare and Hospital Management

  2019cites this paper
• Tratamiento del traumatismo craneoencefálico leve en adultos

  2019cites this paper
• Intraoperative and postoperative effects of TEG-guided platelet transfusion on antiplatelet drug-related intracerebral hemorrhage patients

  2019cites this paper
• The Risk of Deterioration in GCS13–15 Patients with Traumatic Brain Injury Identified by Computed Tomography Imaging: A Systematic Review and Meta-Analysis

  2018influential citation
• Managing mild TBI in adults.

  2018cites this paper
• Complicated Mild Traumatic Brain Injury and the Need for Imaging Surveillance.

  2017cites this paper
• POSITIVE CT BRAIN DURING EARLY POSTOPERATIVE PERIOD IN HEAD INJURY PATIENTS: IMPACT ON CLINICAL COURSE AND OUTCOME

  2017cites this paper
• Epidemiology of Mild Traumatic Brain Injury with Intracranial Hemorrhage: Focusing Predictive Models for Neurosurgical Intervention.

  2017cites this paper