811 Lesional Hemorrhage and Hemorrhage-Negative Patients May Confound the Study of Severe TBI Using Institutional Trauma Databases: Results from a Single Level I Trauma Center

Abstract

INTRODUCTION: Single institution trauma databases are frequently used for outcomes studies in severe traumatic brain injury (sTBI). The etiology of hemorrhage is commonly uncertain at the time of presentation in the neurologically impaired patient, who may be considered potentially traumatic during initial resuscitation. The complexity of intracranial hemorrhage and coding practices serve as barriers to the effective characterization of sTBI patients. METHODS: The LAC+USC trauma database was queried from 2010 to 2018. Patients greater than 18 years of age with initial Glasgow Coma Scale 3 to 8 and abbreviated injury scale head score (AIS-H) of 3 to 5 were selected as those with putative sTBI. Initial and subsequent CT scans of the head and radiology reports were reviewed. Hemorrhages suggestive of spontaneous etiologies including lesional hemorrhages and hypertensive hemorrhages were noted. Review of angiographic studies was performed when relevant. RESULTS: Of 24,763 database patients, 1,310 (5.3%) were adults with putative blunt sTBI. Among this cohort, 119 (9.1%) did not survive to CT scan. Among patients receiving CTH, 87 patients (6.6%) had no acute intracranial findings, and 12 (0.9%) had ischemic stroke or diffuse anoxic injury. Non-traumatic etiologies were present in 31 patients (2.4%), consisting of 8 lesional hemorrhages and 23 hypertensive hemorrhages. CONCLUSIONS: 19% of patients did not meet sTBI criteria. The study of sTBI in institutional databases may be confounded by non-hemorrhagic injuries and non-traumatic intracranial hemorrhages.