gms | German Medical Science

Objective: Traumatic brain injury (TBI) is a major cause of morbidity and mortality. TBI is often associated with the progression of hemorrhagic intracranial lesions (HIL). The use of antiplatelet drugs or anticoagulation can increase the risk of HIL which may cause poor outcome. Identifying factors predicting the progression of HIL may help to provide an optimized management of patients with TBI. Therefore, the aim of this study was to identify predictors for the progression of HIL.

Method: A retrospective analysis was performed by reviewing medical charts of patients with TBI treated over a period of 12 months. The initial CT-scan (CT1) was compared to the follow-up CT-scan (CT2) focusing on the progression of HIL with or without a subsequent surgical procedure. Coagulants were substituted if necessary. Multivariate binary logistic regression analysis was performed to identify factors associated with the progression of HIL and unfavorable outcome. The outcome was assessed according to the modified Rankin Scale (mRS) 1 month after trauma (mRS 0–2 favorable vs. mRS 3–6 unfavorable).

Results: 216 consecutive patients with TBI were treated in our department during this period. 57 patients had no HIL in CT1 and CT2. In 159 patients CT1 revealed HIL. 41 of 159 (26%) patients had a progression of HIL without a subsequent surgical procedure, and 14 out of 159 (9%) with subsequent surgical procedure, respectively. An overall, favorable outcome was achieved in 137 (63%) patients. Multivariate analysis revealed cerebral contusion as the only independent predictor for progression of HIL (p<0.0001, OR 8.9). The presence of acute subdural hematoma (aSDH) in CT1, and a progression of HIL in CT2 with subsequent surgical intervention were independent predictors for unfavorable outcome (p=0.001, OR 4.5, and p=0.005, OR 10.8). The use of APD or OAC had no effect on outcome, and progression of HIL.

Conclusions: HILs are common in patients with TBI. The presence of cerebral contusion in CT1 is an independent predictor for the progression of HIL, while progression of HIL is an independent predictor of unfavorable outcome. The use of APD or OAC had no effect on outcome, and the progression of HIL. Therefore, patients with cerebral contusions require close observation.