Delayed intracranial hemorrhage after trauma

ABSTRACT

Introduction: Delayed Intracranial Hemorrhage (D-ICH), defined as finding of ICH on subsequent imaging after a normal computed tomography of the brain (CTB), is a feared complication after head trauma. The aim of this study was to determine the incidence and severity of D-ICH.

Methods: This retrospective cohort study included patients that presented directly from the scene of injury to an adult major trauma center from Jan 2013 to Dec 2018.

Results: There were 6536 patients who had an initial normal CTB and 23 (0.3%; 95%CI: 0.20–0.47) had D-ICH. There were 653 patients who had a repeat CTB (incidence of D-ICH 3.5%; 95%CI: 2.2–5.2). There was no significant association of D-ICH with age>65 years (OR 1.33; 95%CI: 0.54–3.29), presenting GCS <15 (OR 1.21; 95% CI: 0.52–2.80) and anti-platelet medications (OR 0.68; 95%CI: 0.26–1.74). Exposure to anti-coagulant medications was associated with lower odds of D-ICH (OR 0.23; 95%CI: 0.05–0.99). All cases of D-ICH were diffuse injury type II lesions on the Marshall classification. There were no cases that underwent neurosurgical intervention and no deaths were attributed to D-ICH.

Conclusions: These results question observation of patients with head injury in hospital after a normal CTB for the sole purpose of excluding D-ICH.

KEYWORDS:

• Wound and injuries
• brain injuries
• intracerebral hemorrhage
• computed tomography
• delayed

Disclosure of interest

The authors report no conflict of interest

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.