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Original research
What are the strongest indicators of intracerebral hemorrhage in mild traumatic brain injury?
  1. Panu Teeratakulpisarn1,
  2. Phati Angkasith1,
  3. Thanakorn Wannakul1,
  4. Parichat Tanmit1,
  5. Supatcha Prasertcharoensuk1,
  6. Chaiyut Thanapaisal1,
  7. Narongchai Wongkonkitsin1,
  8. Amnat Kitkhuandee1,
  9. Wattana Sukeepaisarnjaroen2,
  10. Warinthorn Phuttharak3,
  11. Kittisak Sawanyawisuth2
  1. 1Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  2. 2Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  3. 3Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  1. Correspondence to Professor Kittisak Sawanyawisuth; kittisak{at}kku.ac.th; Dr Phati Angkasith; phati{at}kku.ac.th

Abstract

Background Although there are eight factors known to indicate a high risk of intracranial hemorrhage (ICH) in mild traumatic brain injury (TBI), identification of the strongest of these factors may optimize the utility of brain CT in clinical practice. This study aimed to evaluate the predictors of ICH based on baseline characteristics/mode of injury, indications for brain CT, and a combination of both to determine the strongest indicator.

Methods This was a descriptive, retrospective, analytical study. The inclusion criteria were diagnosis of mild TBI, high risk of ICH, and having undergone a CT scan of the brain. The outcome of the study was any type of ICH. Stepwise logistic regression analysis was used to find the strongest predictors according to three models: (1) injury pattern and baseline characteristics, (2) indications for CT scan of the brain, and (3) a combination of models 1 and 2.

Results There were 100 patients determined to be at risk of ICH based on indications for CT of the brain in patients with acute head injury. Of these, 24 (24.00%) had ICH. Model 1 found that injury due to motor vehicle crash was a significant predictor of ICH, with an adjusted OR (95% CI) of 11.53 (3.05 to 43.58). Models 2 and 3 showed Glasgow Coma Scale (GCS) score of 13 to 14 after 2 hours of observation and open skull or base of skull fracture to be independent predictors, with adjusted OR (95% CI) of 11.77 (1.32 to 104.96) and 5.88 (1.08 to 31.99) according to model 2.

Discussion Open skull or base of skull fracture and GCS score of 13 to 14 after 2 hours of observation were the two strongest predictors of ICH in mild TBI.

Level of evidence III.

  • head injury
  • epidural hematoma
  • subdural hematoma
  • intracerebral hemorrhage

Data availability statement

Data are available upon reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2021-000717

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors PTe and PAn conceived and designed the study and defined the intellectual content. TWa, PTa, SPr, CTh, NWo, AKi, WPh, and PA performed the experiment and collected the data. WSu and KSa performed the statistical analysis and data interpretation. PTe and PAn drafted the article. All authors reviewed and approved the final draft of the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.