Cause Of Subarachnoid Hemorrhage Research Articles

Airway Management of Intracranial Aneurysms Associated with Nasopharyngolaryngeal Hemangioma: A Case Report

Intracranial aneurysm is a very common disease, which is an abnormal bulge on the wall of intracranial artery. It is the first cause of subarachnoid hemorrhage. With the development of imaging, the disease is easily diagnosed. A 60-year-old man was diagnosed with anterior communicating artery aneurysm and underwent aneurysm clipping. During routine induction of anesthesia, a nasopharyngolaryngeal hemangioma was visualized under a video laryngoscope. This poses a serious challenge for tracheal intubation. With the assistance of a video laryngoscope and local anesthesia with lidocaine, a 6.5# reinforced endotracheal tube was inserted. Nasopharyngolaryngeal hemangioma is a congenital vascular anomaly characterized by proliferation of endothelial cells. The incidence of infantile and childhood hemangiomas is low, and most spontaneously resolve by the age of 4 to 6 years. Adult nasopharyngolaryngeal hemangioma are extremely rare and are residual lesions from infancy and childhood. Although nasopharyngolaryngeal hemangioma does not clearly affect the quality of life of patients, intracranial hemangioma has caused blurred vision and decreased vision. Therefore, surgery for intracranial aneurysm was necessary for this patient. This case emphasizes the management of unplanned difficult airway of pharyngeal hemangioma and the emergency plan for hemangioma rupture and bleeding. Provide guidance and risk management procedures for nasopharyngotracheal intubation.

Rates of operative intervention and in-hospital mortality following subarachnoid hemorrhage in patients with COVID-19.

COVID-19 had massive effects on the healthcare system and multifactorial implications for the management of intensive care unit and cerebrovascular patients. This study aimed to assess the effect of COVID-19 on the outcomes of patients with aneurysmal subarachnoid hemorrhage (SAH). The National Inpatient Sample (NIS) was used to identify patients with nontraumatic SAH (ICD-10 code I60.x). Patients with nonaneurysmal cerebrovascular malformations or traumatic intracranial injuries were excluded. Only patients managed from April to December 2020 were included in the study given the availability of an ICD-10 code for COVID-19. Data on sociodemographic factors, hospital characteristics, comorbidities, NIS SAH Severity Score (NIS-SSS), surgical treatment, and death were acquired. Multivariable analysis was used to assess predictors of both surgical intervention and in-hospital mortality. In total, 6984 patients met the study criteria, 359 (5.1%) of whom had COVID-19. Those with COVID-19 were more likely to be younger and male and had a higher All Patient Refined Diagnosis-Related Groups illness severity subclass, and NIS-SSS. Moreover, patients with COVID-19 were less likely to undergo surgery (10.0% vs 23.6%, OR 0.35, p < 0.0001) and had significantly higher mortality rates (48.2% vs 22.7%, p < 0.0001). When controlling for other variables, COVID-19 was an independent predictor of death (OR 1.67, p = 0.0002). Aneurysm surgery was performed in 1597 patients (317 open and 1280 endovascular procedures). There was no difference between the cohorts positive and negative for COVID-19 in terms of time to surgery or type of surgery. COVID-19 had significant impacts on patients with nontraumatic SAH. Specifically, patients with COVID-19 were significantly less likely to undergo surgery and had higher in-hospital mortality rates; however, for patients who did undergo procedural intervention, there was no significant difference in the type of intervention. Multiple factors, from medical acuity to healthcare system limitations, may contribute to these findings. Further retrospective research is needed to identify both specific causes of lower intervention rates and other potential nonaneurysmal causes of SAH in patients with COVID-19.

Isolated spinal artery aneurysm: etiology, clinical characteristics, and outcomes.

Isolated spinal aneurysms (ISAs) are rare causes of subarachnoid hemorrhage (SAH), which encompass a highly heterogeneous group of clinical entities with multifarious pathogeneses, clinical characteristics, and treatment strategies. Therefore, knowledge about the ISAs remains inadequate. In this study, the authors present a comprehensive analysis of clinical data associated with ISAs at their institutions to enhance the understanding of this disease. Patients with ISAs confirmed by spinal angiography or surgery at the authors' institutions between 2015 and 2022 were included. Data regarding clinical presentation, lesion location, aneurysm morphology, comorbidities, treatment results, and clinical outcomes were reviewed. Seven patients with ISAs were included in the study. Among them, 4 patients (57.1%) experienced severe headache, and 3 patients (42.9%) reported sudden-onset back pain. Additionally, lower-extremity weakness and urinary retention were observed in 2 of these patients (28.6%). Four of the aneurysms exhibited fusiform morphology, whereas the remaining were saccular. All saccular aneurysms in this series were attributed to hemodynamic factors. Conservative treatment was administered to 3 patients, 2 of whom underwent follow-up digital subtraction angiography, which showed spontaneous occlusion of both aneurysms. Four patients ultimately underwent invasive treatments, including 2 who underwent microsurgery and 2 who received endovascular embolization. One patient died of recurrent SAH, while the remaining 6 patients had a favorable prognosis at the latest follow-up assessment. The morphology of aneurysms may be associated with their etiology. Saccular ISAs are usually caused by pressure due to abnormally increased blood flow, whereas fusiform lesions may be more likely to be secondary to vessel wall damage. The authors found that a saccular spinal aneurysm in young patients with a significant dilated parent artery may be a vestige of spinal cord arteriovenous shunts. ISAs can be managed by surgical, endovascular, or conservative procedures, and the clinical outcome is generally favorable. However, the heterogeneous nature of the disease necessitates personalized treatment decision-making based on specific clinical features of each patient.

Automatic risk prediction of intracranial aneurysm on CTA image with convolutional neural networks and radiomics analysis.

Intracranial aneurysm (IA) is a nodular protrusion of the arterial wall caused by the localized abnormal enlargement of the lumen of a brain artery, which is the primary cause of subarachnoid hemorrhage. Accurate rupture risk prediction can effectively aid treatment planning, but conventional rupture risk estimation based on clinical information is subjective and time-consuming. We propose a novel classification method based on the CTA images for differentiating aneurysms that are prone to rupture. The main contribution of this study is that the learning-based method proposed in this study leverages deep learning and radiomics features and integrates clinical information for a more accurate prediction of the risk of rupture. Specifically, we first extracted the provided aneurysm regions from the CTA images as 3D patches with the lesions located at their centers. Then, we employed an encoder using a 3D convolutional neural network (CNN) to extract complex latent features automatically. These features were then combined with radiomics features and clinical information. We further applied the LASSO regression method to find optimal features that are highly relevant to the rupture risk information, which is fed into a support vector machine (SVM) for final rupture risk prediction. The experimental results demonstrate that our classification method can achieve accuracy and AUC scores of 89.78% and 89.09%, respectively, outperforming all the alternative methods. Our study indicates that the incorporation of CNN and radiomics analysis can improve the prediction performance, and the selected optimal feature set can provide essential biomarkers for the determination of rupture risk, which is also of great clinical importance for individualized treatment planning and patient care of IA.

7T magnetic resonance angiographic imaging of basilar artery perforator aneurysms - initial experience of a non-invasive alternative to DSA.

Perforator aneurysms of the basilar artery (PABA) are rare causes of subarachnoid haemorrhage (SAH) and challenging to diagnose. We present two cases of SAH caused by PABA diagnosed by cone beam computed tomography angiography (CBCTA) and a novel non-invasive method - 7T magnetic resonance imaging (7T MRI). Two patients with SAH, diagnosed with PABA, were imaged on day 9 and 13 after onset, respectively, with CBCTA and 7T MR angiography (MRA) performed on the day after and at follow-up at 3 months. All four 7T MRI examinations in the two patients were technically successful with fully diagnostic images. No endovascular treatment was performed and control with 7T MRA at 3 months showed no remaining aneurysms. PABA can be imaged with 7T MRI - a novel non-invasive method, allowing non-invasive follow-up to monitor this rare cause of SAH.

Cerebral Aneurysm and Interleukin-6: a Key Player in Aneurysm Generation and Rupture or Just One of the Multiple Factors?

Intracranial aneurysm (IA) rupture is a common cause of subarachnoid hemorrhage (SAH) with high mortality and morbidity. Inflammatory interleukins (IL), such as IL-6, play an important role in the occurrence and rupture of IA causing SAH. With this review we aim to elucidate the specific role of IL-6 in aneurysm formation and rupture in preclinical and clinical studies. IL-6 is a novel cytokine in that it has pro-inflammatory and anti-inflammatory signaling pathways. In preclinical and clinical studies of IA formation, elevated and reduced levels of IL-6 are reported. Poor post-rupture prognosis and increased rupture risk, however, are associated with higher levels of IL-6. By better understanding the relationships between IL-6 and IA formation and rupture, IL-6 may serve as a biomarker in high-risk populations. Furthermore, by better understanding the IL-6 signaling mechanisms in IA formation and rupture, IL-6 may optimize surveillance and treatment strategies. This review examines the association between IL-6 and IA, while also suggesting future research directions.

CRANet: a comprehensive residual attention network for intracranial aneurysm image classification

Rupture of intracranial aneurysm is the first cause of subarachnoid hemorrhage, second only to cerebral thrombosis and hypertensive cerebral hemorrhage, and the mortality rate is very high. MRI technology plays an irreplaceable role in the early detection and diagnosis of intracranial aneurysms and supports evaluating the size and structure of aneurysms. The increase in many aneurysm images, may be a massive workload for the doctors, which is likely to produce a wrong diagnosis. Therefore, we proposed a simple and effective comprehensive residual attention network (CRANet) to improve the accuracy of aneurysm detection, using a residual network to extract the features of an aneurysm. Many experiments have shown that the proposed CRANet model could detect aneurysms effectively. In addition, on the test set, the accuracy and recall rates reached 97.81% and 94%, which significantly improved the detection rate of aneurysms.

Detection of Cerebral Aneurysm in Cerebral Arteries Following Non-Invasive CT Angiogram

Background: Cerebral aneurysm is the basic cause of sub-arachnoid hemorrhage; Computed tomographic angiogram is the non-invasive approach to diagnose aneurysm by reconstructing the image in 3D dimension making it possible to locate the aneurysm and differentiate it from other arteries. Objective: Focus of this study was to investigate the accuracy of CTA to detect the aneurysm, its type, location and size. Material and method: Data of 50 patients was taken retrospectively with cost-benefit approach that undergoes non-invasive CTA through Aquilion 64-slices CT machine under post-processing work station. Results: This retrospective study is taken with 50 patients, with a 38 percent positive predictive value and a 62 percent negative predictive value, multi-slice CT properly revealed substantial aneurysm in 19 of 50 cases. Conclusion: 64-slices CT provides high diagnostic accuracy for detecting the aneurysm in cerebral arteries with a non-invasive angiogram procedure.

Activated leukocyte cell adhesion molecule/cluster of differentiation 166 rs10933819 (G>A) variant is associated with familial intracranial aneurysms.

Rupture of intracranial aneurysms (IAs) is the most common cause of subarachnoid hemorrhage (SAH). Currently, there is sufficient evidence to indicate that inflammatory responses contribute to aneurysm rupture. Moreover, the familial occurrence of SAH suggests that genetic factors may be involved in disease susceptibility. In the present study, a clinically proven case of IA in a patient who is a heterozygous mutation carrier of the activated leukocyte cell adhesion molecule (ALCAM)/cluster of differentiation 166 (CD166) gene, is reported. Genomic DNA was extracted from two siblings diagnosed with SAH and other available family members. A variant prioritization strategy that focused on functional prediction, frequency, predicted pathogenicity, and segregation within the family was employed. Sanger sequencing was also performed on the unaffected relatives to assess the segregation of variants within the phenotype. The verified mutations were sequenced in 145 ethnicity-matched healthy individuals. Based on whole exome sequencing data obtained from three individuals, two of whom were diagnosed with IAs, the single-nucleotide variant rs10933819 was prioritized in the family. Only one variant, rs10933819 (G>A), in ALCAM co-segregated with the phenotype, and this mutation was absent in ethnicity-matched healthy individuals. Collectively, ALCAM c1382 G>A p.Gly229Val was identified, for the first time, as a pathogenic mutation in this IA pedigree.

Pediatric Subarachnoid Hemorrhage: Rare Events with Important Implications

Rupture of an aneurysm is the leading cause of subarachnoid hemorrhage (SAH) which results in accumulation of blood between the arachnoid and pia mater, consequently increasing intracranial pressure. This often results in life threatening conditions like herniation or clinical presentations including focal neurological deficits. In children, these events, although rare, have significant implications. Pediatric SAH is associated with better outcomes in the hospital setting and may even be prevented proactively by the recognition of potential risk factors. Specifically, better recognition of genetic predispositions, metastatic lesions, and infectious causes of aneurysms is important to understand their growth and prevent hemorrhagic events. This review highlights the causes of pediatric SAH, reviews the models of current understanding of this etiology, and discusses the current treatment schema to provide a succinct summary and highlight gaps in current knowledge. This may lead to future investigations aimed at further improving prevention strategies, patient care, and patient outcomes.

Antepartum cerebral angiopathy presenting as middle cerebral artery aneurysm rupture – A rare case report from India

The incidence of middle cerebral artery aneurysm rupture in pregnancy is rare. Rupture of an intracranial aneurysm is the most common cause of subarachnoid hemorrhage in pregnancy and during puerperium. Intracranial aneurysm rupture during pregnancy is disastrous for the mother as well as the fetus. We report a case of a dissecting left middle cerebral artery aneurysm in a 25-year-old woman, G2P1L1, at 18 weeks of gestation, who presented with a 1-day history of giddiness, slurring of speech, and facial deviation to the left.

Cervical intradural extramedullary cavernous malformation as a rare cause of subarachnoid hemorrhage without spinal dysfunction: illustrative case

BACKGROUNDIntradural extramedullary cavernoma is a very rare lesion of the spinal cord, especially of the cervical spine. Its clinical presentation can vary with symptoms of sensory or motor deficits and even with symptoms of subarachnoid hemorrhage (SAH).OBSERVATIONSThe authors present a case of a 45-year-old man with SAH with prolonged neck pain and increasing headache confirmed by lumbar puncture. Head computed tomography revealed only discrete blood deposits in the right frontal and biparietal lobes. The finding of pan-cerebral angiography was negative for the cause of bleeding. Spinal magnetic resonance imaging revealed an intradural extramedullary mass lesion at cervical level C5–6. The finding of subsequent cervical angiography was negative. The diagnosis of a cavernous malformation was confirmed histopathologically after surgery. The cavernoma was completely removed, and full recovery of the initial symptoms was achieved.LESSONSSpinal lesions should be considered in the diagnostic work-up for SAH with excluded origin of bleeding in cranial neuroimaging. An intradural extramedullary cavernous malformation is an extremely rare entity in the differential diagnosis of SAH, and surgical resection is the treatment of choice to prevent further bleeding and neurological deficits.

Subarachnoid haemorrhage following spinal anaesthesia– A dreaded complication

We present a female patient posted for fixation of fracture femur under subarachnoid block. After spinal anaesthesia she developed hypotension and cardiac arrest. Subarachnoid haemorrhage was diagnosed by CT scan of head when she did not regain the consciousness. Inspite of all the efforts she had a fatal outcome. We discuss the probable causes of subarachnoid haemorrhage after a simple procedure like spinal anaesthesia with an unusual presentation.

Abstract TMP8: The Feasibility Of Machine Learning In Predicting Intracranial Aneurysm Rupture Risk

Background: Intracranial aneurysm (IA) is one of the most common causes of subarachnoid hemorrhage which is associated with high mortality and morbidity. Predicting aneurysms’ rupture risk has been an ongoing challenge clinically. The objective of this study is to utilize machine learning algorithms to predict IA’s rupture status based on simple parameters that can be measured in the daily clinical setting. Methods: A total of 448 IA cases with known rupture status (228 unruptured and 220 ruptured) were collected across three tertiary hospitals between November 2017 and November 2020. Twelve demographic and morphological parameters were obtained from all cases. Six machine learning models, namely Naive Bayes, Support Vector Machine, K-Nearest Neighbours, Gradient Boosting, Decision tree and Random Forest algorithms were applied to the dataset. Sensitivity, specificity and accuracy of each model was calculated along with Area Under the Curve (AUC) and F1 score. Furthermore, the relevant importance of all 12 variables was assessed. Results: Gradient Boosting and Random Forest algorithms were the ML algorithms with the highest AUC of 0.69, followed by Naive Bayes (AUC=0.66). Overall, Random Forest algorithm was the best-formed model with 67% sensitivity and 63% specificity. Support Vector Machine model gave the lowest favorable AUC of 0.45 with 45% sensitivity and 48% specificity. The most significant variable was the aneurysm neck width, followed by the parent artery diameter. Conclusions: Machine learning has the potential to assist with the IA’s rupture prediction by using simple variables that can be easily obtained in clinical practice. Further research, especially a larger sample size is required to improve diagnostic accuracy before its clinical translation.

Flow Diverter Treatment of Ruptured Basilar Artery Perforator Aneurysms

PurposeRuptured basilar artery perforator aneurysms (BAPAs) represent a very rare cause of subarachnoid hemorrhage and an under-reported subtype of cerebral aneurysm. There is no consensus for the optimal treatment strategy (conservative vs. surgical vs. various endovascular approaches). We aim to present a multicenter experience of BAPA treatment using flow-diverter (FD) stents.MethodsAt five tertiary neurovascular centers, all cases of ruptured BAPAs treated by FD were retrospectively collected. Baseline imaging and clinical characteristics, complications, as well as early and long-term angiographic and clinical outcome (mRS) were analyzed.ResultsEighteen patients (mean age, 57 years; SD, ±10.7 years) with acute SAH related to a BAPA were treated using 18 FD stents. Aneurysms were detected on initial imaging study in 28%; delayed diagnosis was triggered by clinical deterioration due to rebleeding in 15%. No rebleeding after FD was seen, 28% developed FD-related ischemic complications. At long term (n = 16), overall mortality was 13% (2/16), and favorable outcome (mRS 0–2) was 81% (13/16). All BAPAs (n = 13) were completely occluded at long-term angiographic follow-up.ConclusionIn our multicenter experience, FD treatment of ruptured BAPAs appears to have comparable safety and efficacy outcomes to FD treatment of other ruptured posterior circulation aneurysms as well as to the conservative management of BAPAs. This treatment strategy for a ruptured BAPA achieved a high rate of angiographic occlusion and favorable clinical outcome; however, as the conservative management also seems to offer similar clinical outcomes an individualized treatment decision is warranted. Future prospective studies comparing both approaches are required.

Clinical Treatment and Prognostic Analysis of Patients with Aneurysmal Subarachnoid Hemorrhage.

Subarachnoid hemorrhage (SAH) is a serious disease caused by blood flow into the subarachnoid space due to rupture of blood vessels. All diseases that cause intracranial hemorrhage are the cause of subarachnoid hemorrhage. Among them, due to the particularity of intracranial blood vessels, intracranial blood vessels are more prone to aneurysms than other parts. Therefore, the incidence of aneurysmal subarachnoid hemorrhage (aSAH) is extremely high. The purpose of this article is to study the clinical treatment and prognosis analysis of aSAH patients. This article first summarizes the current status of SAH research at home and abroad and summarizes its potential value and significance. On this basis, an in-depth study of the clinical treatment of aSAH patients has been carried out. The physiological mechanism and clinical general differences of aSAH were studied and analyzed. This article systematically describes the application of CTP in the treatment and prognosis analysis of aSAH patients. Then, it will use a comparative analysis method, interdisciplinary method, and other research forms to carry out experimental research on the theme of this article. Research shows that rebleeding and blood sodium are the main factors for cerebral ischemia caused by aSAH.

Diagnosis and Management of Traumatic Subarachnoid Hemorrhage: Protocol for a Scoping Review.

BackgroundGlobally, 69 million people suffer from traumatic brain injury (TBI) each year and TBI is the most common cause of subarachnoid hemorrhage (SAH). Traumatic SAH (TSAH) has been described as an adverse prognostic factor leading to progressive neurological deterioration and an increase in morbidity and mortality, but there are a limited number of studies which evaluate recent trends in the diagnostic and management of SAH in the context of trauma.ObjectiveThe objective of this scoping review was to understand the extent and type of evidence in relation to the diagnostic criteria and management of TSAH.MethodsThis scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. A 3-step search strategy (an initial limited search in PubMed and Scopus databases; a main search of EMBASE, Web of Science, EBSCO, MEDLINE; and manual searches of reference lists of included articles) will be utilized. The search will be limited to studies with human participants and published in English, Spanish, and French between 2005 and 2020. This review will consider studies of adolescent and adult patients with SAH secondary to trauma. Study selection will be performed by 2 authors (DG and LF) in a 2-phase process; if any disagreement arises, a third author (AR) will be consulted. Data to be extracted from each study will include population, intervention, comparator and outcome measures, and a summary of findings. Citation screening, full-text review, risk of bias assessment, and extraction of study characteristics and outcomes will be carried out using a web-based software platform that streamlines the production of scoping reviews.ResultsEthics approval is not required for this systematic review, as there will be no patient involvement. The search for this systematic review commenced in December 2020, and we expect to publish the findings in early 2021. The plan for dissemination is to publish review findings in a peer-reviewed journal and present findings at conferences that engage the most pertinent stakeholders.ConclusionsThis scoping review will serve as an initial step in providing more evidence for health care professionals, economists, and policymakers so that they might devote more resources toward this significant problem affecting both health and economic outcomes worldwide.International Registered Report Identifier (IRRID)PRR1-10.2196/26709

Multiple overlapping stent-assisted coiling improves efficacy and safety of treatment for complex intracranial aneurysms: a randomized trial

BackgroundIntracranial aneurysm rupture is the main cause of subarachnoid hemorrhage, leading to high disability and mortality. This study aimed to evaluate the clinical treatment effects of multiple overlapping stent-assisted coiling for complex intracranial aneurysms.MethodsWe conducted a randomized, controlled, single-blinded clinical trial among 168 patients diagnosed with complex intracranial aneurysms. Treatment allocation to either single stent (SS) group or multiple stent (MS) group was randomized at 1:1 ratio using a Web-based platform. The O’Kelly–Marotta (OKM) grading scale was used to evaluate the degree of aneurysm occlusion after operation and during follow-up. Good aneurysm occlusion was defined as OKM grade C–D. The modified Rankin Scale (mRS) was used to evaluate the neurological status and the clinical outcome of patients.ResultsEfficacy comparative analysis demonstrated that major recurrence of aneurysms was significantly reduced in the MS group (P = 0.012). In addition, the MS group displayed significantly reduced number of patients with mRS between 3 and 6 (P = 0.007) and increased number of patients with mRS between 0 and 1 (P = 0.034). Furthermore, the MS group showed increased percentage of patients with OKM grade C–D (P = 0.041). Compared with the SS group, the MS group exhibited decreased mortality (P = 0.037) and morbidity (P = 0.035).ConclusionsMultiple overlapping stent-assisted coiling significantly improved the clinical treatment effects and provided a new method for complex intracranial aneurysms.

Prevalence of asymptomatic unruptured intracranial aneurysm in the elderly Thai population

Subarachnoid hemorrhage is one of the devastating cerebrovascular event. Ruptured intracranial aneurysm is the leading cause of subarachnoid hemorrhage. Early detection of unruptured intracranial aneurysm (UIA) may help prevent subarachnoid hemorrhage. This study aimed to identify the prevalence of asymptomatic UIA among elderly Thai population.

Traumatic Subarachnoid Hemorrhage: A Scoping Review.

Sixty-nine million people have a traumatic brain injury (TBI) each year, and TBI is the most common cause of subarachnoid hemorrhage (SAH). Traumatic SAH (TSAH) has been described as an adverse prognostic factor leading to progressive neurological deterioration and increased morbidity and mortality. A limited number of studies, however, evaluate recent trends in the diagnosis and management of SAH in the context of trauma. The objective of this scoping review was to understand the extent and type of evidence concerning the diagnostic criteria and management of TSAH. This scoping review was conducted following the Joanna Briggs Institute methodology for scoping reviews. The review included adults with SAH secondary to trauma, where isolated TSAH (iTSAH) refers to the presence of SAH in the absence of any other traumatic radiographic intracranial pathology, and TSAH refers to the presence of SAH with the possibility or presence of additional traumatic radiographic intracranial pathology. Data extracted from each study included study aim, country, methodology, population characteristics, outcome measures, a summary of findings, and future directives. Thirty studies met inclusion criteria. Studies were grouped into five categories by topic: TSAH associated with mild TBI (mTBI), n = 13), and severe TBI (n = 3); clinical management and diagnosis (n = 9); imaging (n = 3); and aneurysmal TSAH (n = 1). Of the 30 studies, two came from a low- and middle-income country (LMIC), excluding China, nearly a high-income country. Patients with TSAH associated with mTBI have a very low risk of clinical deterioration and surgical intervention and should be treated conservatively when considering intensive care unit admission. The Helsinki and Stockholm computed tomography scoring systems, in addition to the American Injury Scale, creatinine level, age decision tree, may be valuable tools to use when predicting outcome and death.