Patients with traumatic subarachnoid hemorrhage are at low risk for deterioration or neurosurgical intervention.

Abstract

BACKGROUND:

Current standard of care for patients with traumatic intracranial hemorrhage (TIH) includes neurosurgical consultation and/or transfer to a trauma center with neurosurgical backup. We hypothesize that a set of low-risk criteria can be applied to such patients to identify those who may not require neurosurgical evaluation.

METHODS:

This is a cross-sectional study of consecutive emergency department patients in 2009 and 2010 with TIH on computerized tomographic scan owing to blunt head trauma. Patients presented to an urban academic Level I trauma center (volume, 92,000) were older than 15 years and had a Glasgow Coma Scale (GCS) score of 13 or greater. Charts were abstracted using a standardized data form by two emergency physicians. Our principal outcome was deterioration represented by a composite of neurosurgical intervention, clinical deterioration, or worsening computerized tomographic scan result.

RESULTS:

During the study period, 404 patients were seen with TIH and met our inclusion criteria, and 48 of those patients (11.8%) deteriorated. Patients with isolated subarachnoid hemorrhage, were less likely to deteriorate (odds ratio [OR], 0.08; 95% confidence interval [CI], 0.011-0.58). Characteristics associated with deterioration were subdural hematomas (OR, 2.63; 95% CI, 1.198-5.81) or presenting GCS of less than 15 (OR, 2.12; 95% CI, 1.01-4.43).The use of anticoagulant medications or antiplatelet agents were not associated with deterioration for warfarin, aspirin, or clopidogrel; however bleeding diatheses were corrected with vitamin K, fresh frozen plasma, and platelets as necessary.

CONCLUSION:

Patients with isolated traumatic subarachnoid hemorrhage are at low risk for deterioration. These individuals may not need neurosurgical consultation or transfer to a trauma center where neurosurgical backup is available. Those patients with subdural hematoma or a GCS of less than 15 have a higher risk of deterioration and require neurosurgical evaluation.

LEVEL OF EVIDENCE:

Therapeutic/care management, level IV.

• Authors: Pierre Borczuk, Joshua Penn, David Peak, Yuchiao Chang
• Journal: The journal of trauma and acute care surgery (J Trauma Acute Care Surg) Vol. 74 Issue 6 Pg. 1504-9 (Jun 2013) ISSN: 2163-0763 [Electronic] United States
• PMID: 23694879 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Cross-Sectional Studies
• Female
• Glasgow Coma Scale
• Head Injuries, Closed (diagnosis, diagnostic imaging, surgery)
• Humans
• Logistic Models
• Male
• Middle Aged
• Risk Factors
• Subarachnoid Hemorrhage, Traumatic (diagnosis, diagnostic imaging, surgery)
• Tomography, X-Ray Computed
• Trauma Centers (statistics & numerical data)
• Young Adult