Abstract
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.
Highlights
Mild traumatic brain injury (TBI) patients with initial traumatic intracranial hemorrhage and without immediate neuro-surgical intervention require close monitoring of their neurologic status
Because there is a need for better delineation of potential risk factors and clinical features in this specific subgroup, this study aimed to analyze the clinical features, neuro-imaging findings, and measurements to determine the potential risk factors predictive of surgical intervention in patients with mild TBI and traumatic intracranial hemorrhage (tICH) on admission
Three hundred and forty adult patients with acute TBI and tICH on initial brain CT admitted within 24 h after onset of acute TBI to Kaohsiung Chang Gung Memorial Hospital, a 2715-bed acute-care teaching medical center in southern Taiwan providing both primary and tertiary referral care, were enrolled
Summary
Mild 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. Shih et al World Journal of Emergency Surgery (2016) 11:13 intensive care unit (ICU) monitoring to prevent poor outcome of mild TBI patients [1,2,3,4, 6]. Because there is a need for better delineation of potential risk factors and clinical features in this specific subgroup, this study aimed to analyze the clinical features, neuro-imaging findings, and measurements to determine the potential risk factors predictive of surgical intervention in patients with mild TBI and tICH on admission
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