Citation

Orlando A, Levy AS, Carrick MM, Tanner A, Mains CW, Bar-Or D. World Neurosurg. 2017; 107: 94-102.

Affiliation

Swedish Medical Center, Trauma Research Department, Englewood, CO, USA; St. Anthony Hospital, Trauma Research Department, Lakewood, CO, USA; Medical City Plano, Trauma Services Department, Plano, TX, USA; Penrose Hospital, Trauma Services Department, Colorado Springs, CO, USA; Rocky Vista University College of Osteopathic Medicine, Parker, CO, USA. Electronic address: dbaror@ampiopharma.com.

Copyright

(Copyright © 2017, Elsevier Publishing)

DOI

10.1016/j.wneu.2017.07.130

PMID

28774762

Abstract

OBJECTIVE: To adumbrate differences in neurosurgical intervention (NI) rates between intracranial hemorrhage (ICH) types in mild traumatic brain injuries (mTBIs), and help identify which ICH types are most likely to benefit from the creation of predictive models for NI.

METHODS: This was a multi-center retrospective study of adult patients over three years at four Trauma Centers in the USA. Patients were included if they presented with a mTBI (GCS 13-15) and a head CT positive for ICH. Patients were excluded for skull fractures, "unspecified hemorrhage", or coagulopathy. The primary outcome was NI. Stepwise multivariable logistic regression models were built to analyze the independent association between ICH variables and outcome measures.

RESULTS: 1,876 patients were included in our study. The NI rate was 6.7%. There was a significant difference in the rate of NI by ICH type. Subdural hematomas carried the highest rate of NI (15.5%), and accounted for 78% of all NIs. Isolated SAHs carried the lowest, non-zero, NI rate (0.19%). Logistic regression models identified ICH type as the most influential independent variable when examining NI. A model predicting NI for isolated SAHs would require 26,928 patients, but a model predicting NI for isolated SDHs would only require 328 patients.

CONCLUSION: Our study highlights the disparate NI rates among ICH types in the mTBI population, and identified mild, isolated SDHs as most appropriate for the construction of predictive NI models. Increased healthcare efficiency will be driven by an accurate understanding of risk, which can only come from accurate predictive models.

Copyright © 2017 Elsevier Inc. All rights reserved.

Language: en

Keywords

adult; intracranial hemorrhage; mild; neurosurgical intervention; traumatic brain injury