Abstract
BackgroundThe active extravasation of contrast on CT angiography (CTA) in primary intracerebral hemorrhages (ICH) is recognized as a predictive factor for ICH expansion, unfavorable outcomes and mortality. However, few studies have been conducted on the setting of traumatic brain injury (TBI).PurposeTo perform a literature systematic review and meta-analysis of the association of contrast extravasation on cerebral hemorrhagic contusion expansion, neurological outcomes and mortality.Data sourcesThe PubMed, Cochrane Library, Medline, Scielo, VHL and IBECS databases up to September 21, 2019, were searched for eligible studies.Study selectionA total of 505 individual titles and abstracts were identified and screened. A total of 36 were selected for full text analysis, out of which 4 fulfilled all inclusion and exclusion criteria.Data analysisAll 4 studies yielded point estimates suggestive of higher risk for hematoma expansion with contrast extravasation and the summary RR was 5.75 (95%CI 2.74–10.47, p<0.001). Contrast extravasation was also associated with worse neurological outcomes (RR 3.25, 95%CI 2.24–4.73, p<0.001) and higher mortality (RR 2.77, 95%CI 1.03–7.47, p = 0.04).Data synthesisThis study is a Systematic Review and Meta-Analysis revealed the extravasation of contrast is a useful imaging sign to predict hematoma expansion, worse neurological outcomes and higher mortality.LimitationsOnly four articles were selected.ConclusionsThe extravasation of contrast in the setting of TBI is a useful imaging sign to predict hematoma expansion, worse neurological outcomes and higher mortality.
Highlights
Traumatic brain injury (TBI) is the leading cause of death in victims of trauma and may results in the development of intra-axial contusions, of which hematoma is a key component
Hemorrhage progression was defined as a greater than 30% or more than 5 mL increase in the contusion hematoma volume on computed tomography (CT) performed at the time of neurologic deterioration or on follow-up CT at 24 hours or 72 hours
The contrast extravasation was identified in 41% of the patients (9/22) and was significantly associated with hemorrhage expansion, worse neurological outcomes and the need for surgical intervention
Summary
Traumatic brain injury (TBI) is the leading cause of death in victims of trauma and may results in the development of intra-axial contusions, of which hematoma is a key component. Some variables have been studied and are potential predictors of cerebral hemorrhagic contusion hematoma: patient age, initial hematoma volume, acute subdural hematoma, traumatic subarachnoid hemorrhage, midline shift, decompressive craniectomy, time delay from TBI to admission head CT, need for cardiopulmonary resuscitation, hyperglycemia and coagulopathy (either by previous antiplatelet / anticoagulant use or trauma induced coagulopathy) [6,7,8, 10, 13,14,15, 18,19,20,21,22,23]. To perform a literature systematic review and meta-analysis of the association of contrast extravasation on cerebral hemorrhagic contusion expansion, neurological outcomes and mortality. A total of 36 were selected for full text analysis, out of which 4 fulfilled all inclusion and exclusion criteria
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