BACKGROUND: Mild traumatic brain injury is a clinical diagnosis predicated on a patient's neurologic status and encompasses a variety of pathologies on computed tomography. We wondered whether isolated traumatic subarachnoid hemorrhage (iSAH) without other intracranial pathologic diagnosis is a more benign form of minor head injury that does not warrant extensive (and expensive) observation and follow-up. METHODS: This is a retrospective review of patients identified prospectively via a trauma registry during a period of 7 years, who had the computed tomographic finding of iSAH on admission scan and a Glasgow Coma Scale (GCS) score of 13 or greater. RESULTS: There were 478 patients identified, with a mean age 61 years, and 223 were male. Median Injury Severity Score (ISS) was 10 (range, 9-48), and the distribution was 415, 54, and 12 for those with GCS score of 15, 14, and 13, respectively. In-hospital follow-up imaging in nine patients demonstrated increased pathologic findings, but subsequent imaging showed stable or decreasing blood, and none experienced a neurologic decline or underwent a neurosurgical procedure.Among those with no other injuries (ISS = 9, n = 118) patients spent a mean of 2.0 (95% confidence interval, 1.1-2.9) days in intensive care unit and 4.9 (95% confidence interval, 3.9-6.0) days in hospital. The likelihood of discharge home was significantly related to age (p < 0.0001), ISS (p < 0.01), and admission GCS (p < 0.01) (stepwise logistic regression), but not progression of SAH.At 6-week follow-up, one patient (0.2%) developed bilateral chronic subdurals requiring drainage, without neurologic sequela. CONCLUSION: In this largest reported series to date of iSAH in the setting of mild traumatic brain injury, the finding seems to be benign and can likely be managed without routine follow-up imaging or intensive care unit admission in the absence of other significant trauma. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III; therapeutic study, level IV.
BACKGROUND: Mild traumatic brain injury is a clinical diagnosis predicated on a patient's neurologic status and encompasses a variety of pathologies on computed tomography. We wondered whether isolated traumatic subarachnoid hemorrhage (iSAH) without other intracranial pathologic diagnosis is a more benign form of minor head injury that does not warrant extensive (and expensive) observation and follow-up. METHODS: This is a retrospective review of patients identified prospectively via a trauma registry during a period of 7 years, who had the computed tomographic finding of iSAH on admission scan and a Glasgow Coma Scale (GCS) score of 13 or greater. RESULTS: There were 478 patients identified, with a mean age 61 years, and 223 were male. Median Injury Severity Score (ISS) was 10 (range, 9-48), and the distribution was 415, 54, and 12 for those with GCS score of 15, 14, and 13, respectively. In-hospital follow-up imaging in nine patients demonstrated increased pathologic findings, but subsequent imaging showed stable or decreasing blood, and none experienced a neurologic decline or underwent a neurosurgical procedure.Among those with no other injuries (ISS = 9, n = 118) patients spent a mean of 2.0 (95% confidence interval, 1.1-2.9) days in intensive care unit and 4.9 (95% confidence interval, 3.9-6.0) days in hospital. The likelihood of discharge home was significantly related to age (p < 0.0001), ISS (p < 0.01), and admission GCS (p < 0.01) (stepwise logistic regression), but not progression of SAH.At 6-week follow-up, one patient (0.2%) developed bilateral chronic subdurals requiring drainage, without neurologic sequela. CONCLUSION: In this largest reported series to date of iSAH in the setting of mild traumatic brain injury, the finding seems to be benign and can likely be managed without routine follow-up imaging or intensive care unit admission in the absence of other significant trauma. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III; therapeutic study, level IV.
Authors: Herb A Phelan; Adam A Richter; William W Scott; Jeffrey H Pruitt; Christopher J Madden; Kim L Rickert; Steven E Wolf Journal: J Neurotrauma Date: 2014-08-27 Impact factor: 5.269
Authors: Aaron C Shpiner; Nikolay Bugaev; Ron Riesenburger; Isaac Ng; Janis L Breeze; Sandra S Arabian; Reuven Rabinovici Journal: J Clin Neurosci Date: 2018-11-09 Impact factor: 1.961
Authors: Isaac Ng; Nikolay Bugaev; Ron Riesenburger; Aaron C Shpiner; Janis L Breeze; Sandra S Arabian; Reuven Rabinovici Journal: J Clin Neurosci Date: 2018-10-17 Impact factor: 1.961
Authors: Carl Marincowitz; Fiona E Lecky; William Townend; Aditya Borakati; Andrea Fabbri; Trevor A Sheldon Journal: J Neurotrauma Date: 2018-01-11 Impact factor: 5.269