Clinical predictive score of intracranial hemorrhage in mild traumatic brain injury

Figures & data

Table 1 Clinical characteristics of mild TBI patients categorized by head CT scan results for any intracranial hemorrhage (CT+)

Characteristics	CT(+) (n=100)		CT(−) (n=608)		p-value	AuROC (95% CI)
	n	%	n	%
Gender, male	64	64.0	227	45.6	0.001	0.41 (0.37, 0.45)
Age ≥60 years	58	58.0	446	73.4	0.003	0.42 (0.39, 0.46)
GCS
15	71	71.0	557	91.6	<0.001	0.61 (0.57, 0.64)
14	7	7.0	30	4.9
13	22	22.0	21	3.5
Clinical signs of skull fracture	8	8.0	2	0.3	<0.001	0.54 (0.50, 0.58)
Clinical signs of basilar skull fracture	9	9.0	1	0.2	<0.001	0.54 (0.51, 0.58)
GCS drop ≥2 points	13	13.0	15	2.5	<0.001	0.55 (0.51, 0.59)
Posttraumatic vomiting	13	13.0	21	3.5	<0.001	0.55 (0.51, 0.58)
Focal neurological signs	31	31.0	42	6.9	<0.001	0.62 (0.58, 0.66)
Seizure	3	3.0	17	2.8	0.754	0.50 (0.46, 0.54)
Headache	24	24.7	119	19.6	0.276	0.53 (0.49, 0.56)
Severe headache	39	39.0	7	1.2	<0.001	0.69 (0.65, 0.72)
Posttraumatic amnesia	48	48.0	106	17.5	<0.001	0.65 (0.62, 0.69)
Transient loss of consciousness	54	54.0	96	15.8	<0.001	0.69 (0.66, 0.72)
Large extracranial hematoma/severe maxillofacial injury	17	17.0	65	10.7	0.090	0.53 (0.49, 0.57)
Anticoagulants
ASA	27	27.0	93	15.3	0.006	0.56 (0.52, 0.60)
Plavix	3	3.0	21	3.5	0.552	0.50 (0.46, 0.53)
Warfarin	2	2.0	21	3.5	0.759	0.49 (0.46, 0.53)
Injury
Fall >20 ft	5	5.0	4	0.7	0.004	0.52 (0.48, 0.56)
Speed >40 mph	9	9.3	29	4.8	0.087	0.52 (0.49, 0.56)
Drug/alcohol intoxication	6	6.0	26	4.3	0.435	0.51 (0.47, 0.55)

Note: CT(−) means without intracranial hemorrhage.

Abbreviations: AuROC, area under the receiver operating characteristic curve; CT, computer tomography; GCS, Glasgow Coma Scale; TBI, traumatic brain injury; ASA, acetylsalicylic acid.

Table 2 Predictors of intracranial hemorrhage and assigned item score in mild TBI patients

Predictors	Category	aOR	95% CI	p-value	Coefficient*	Score
Posttraumatic vomiting more than two times	No	1.00	Reference	–	–	0
	Yes	2.27	0.75–6.87	0.148	0.82	1.5
Severe headache	No	1.00	Reference	–	–	0
	Yes	99.81	37.38–266.50	<0.001	4.60	7.5
Transient loss of consciousness	No	1.00	Reference	–	–	0
	Yes	5.85	2.92–11.71	<0.001	1.77	3
Posttraumatic amnesia	No	1.00	Reference	–	–	0
	Yes	1.84	0.90–3.76	0.097	0.61	1
Focal neurological signs	No	1.00	Reference	–	–	0
	Yes	10.43	4.97–21.89	<0.001	2.34	4
Clinical signs of skull fracture	No	1.00	Reference	–	–	0
	Yes	34.13	4.37–266.53	0.001	3.53	6
Base of skull fracture	No	1.00	Reference	–	–	0
	Yes	139.38	13.64–1,424.24	<0.001	4.94	8

Note:

* Coefficients from multivariable binary logistic regression.

Abbreviations: aOR, adjusted odds ratio; TBI, traumatic brain injury.

Figure 1 The AuROC and 95% CI of the predictive power of the clinical risk score for intracranial hemorrhage in mild TBI patients.

Abbreviations: AuROC, area under the receiver operating characteristic curve; TBI, traumatic brain injury.

Figure 2 Observed risk (circles) vs score-predicted risk (solid line) of intracranial hemorrhage in MTBI patients.

Abbreviation: MTBI, mild traumatic brain injury.

Table 3 Distribution of CT(+) vs CT(−) in low-, moderate-, and high-probability categories, LHR+, and 95% CI for intracranial hemorrhage in mild TBI patients

Probability categories	Score	CT(+) (n=99)		CT(−) (n=602)		LHR+	95% CI	p-value
		n	%	n	%
Low	<3	10	10.1	468	77.7	0.13	0.07–0.23	<0.001
Moderate	3–6	28	28.3	116	19.3	1.47	1.03–2.09	0.030
High	>6	62	62.6	18	3.0	20.61	12.74–33.33	<0.001

Abbreviations: CT, computer tomography; LHR+, likelihood ratio of positive result; TBI, traumatic brain injury.

Table 4 Comparison of risk factors for intracranial hemorrhage in mild TBI patients by various studies

Risk predictors	Smits et al^Citation13	Ibanez et al^Citation14	Fabbri et al^Citation15	This study
Focal neurological signs	2 (1–3)	7 (2–25)	19 (13–28)	7.2 (2.8–18.4)
Clinical signs of basilar skull fracture	14 (8–22)	11 (6–23)	10 (6–16)	173.4 (14.0–2,141.3)
Transient loss of consciousness	2 (1–3)	7 (4–11)	2 (2–3)	5.8 (2.7–12.3)
Posttraumatic amnesia	1.7 (1–2)	3 (2–5)	8 (6–12)	1.9 (0.9–4)
Headache	1.4 (1–2)	1 (0.8–2)	–	0.6 (0.3–1.5)
Severe headache	–	3 (2–6)	–	94.5 (33.5–266.7)
Posttraumatic vomiting	3 (2–4)	4 (2–7)	5 (3–8)	3.0 (0.9–9.9)
Seizure	3 (1–10)	2 (0.3–17)	3 (2–5)	0.4 (0.1–2.5)
Drug/alcohol intoxication	1 (0.6–2)	1 (0.3–3)	–	1.3 (0.4–4.4)
Anticoagulants	2 (1–4)	4 (3–7)	8 (3–9)	2.1 (0.4–10.7)
Age ≥60 years	–	2 (1–3)	2 (1–3)	1.0 (0.5–2.0)
Dangerous mechanisms*	2 (1–4)	–	3 (2–4)	–

Notes: Data are presented as odds ratio and 95% CI (in parenthesis).

* Indicated a motor vehicle, an occupant ejected from a motor vehicle, or a fall from an elevation of ≥3 ft or five stairs.⁶

Abbreviation: TBI, traumatic brain injury.

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