Randall Z Allison1, Kazuma Nakagawa2,3, Michael Hayashi4,5, Daniel J Donovan2,4, Matthew A Koenig6,7. 1. Division of Neurosurgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA. 2. Department of Surgery, Neuroscience Institute, The Queen's Medical Center, 1301 Punchbowl Street- QET5, Honolulu, HI, 96813, USA. 3. Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA. 4. Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA. 5. Department of Surgery, The Queen's Medical Center, Honolulu, HI, USA. 6. Department of Surgery, Neuroscience Institute, The Queen's Medical Center, 1301 Punchbowl Street- QET5, Honolulu, HI, 96813, USA. mkoenig@queens.org. 7. Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA. mkoenig@queens.org.
Abstract
BACKGROUNDS: After traumatic brain injury (TBI), hemorrhagic progression of contusions (HPCs) occurs frequently. However, there is no established predictive score to identify high-risk patients for HPC. METHODS: Consecutive patients who were hospitalized (2008-2013) with non-penetrating moderate or severe TBI were studied. The primary outcome was HPC, defined by both a relative increase in contusion volume by ≥30 % and an absolute increase by ≥10 mL on serial imaging. Logistic regression models were created to identify independent risk factors for HPC. The HPC Score was then derived based on the final model. RESULTS: Among a total of 286 eligible patients, 61 (21 %) patients developed HPC. On univariate analyses, HPC was associated with older age, higher initial blood pressure, antiplatelet medications, anticoagulants, subarachnoid hemorrhage (SAH) subdural hematoma (SDH), skull fracture, frontal contusion, larger contusion volume, and shorter interval from injury to initial CT. In the final model, SAH (OR 6.33, 95 % CI, 1.80-22.23), SDH (OR 3.46, 95 % CI, 1.39-8.63), and skull fracture (OR 2.67, 95 % CI, 1.28-5.58) were associated with HPC. Based on these factors, the HPC Score was derived (SAH = 2 points, SDH = 1 point, and skull fracture = 1 point). This score had an area under the receiver operating curve of 0.77. Patients with a score of 0-2 had a 4.0 % incidence of HPC, while patients with a score of 3-4 had a 34.6 % incidence of HPC. CONCLUSIONS: A simple HPC Score was developed for early risk stratification of HPC in patients with moderate or severe TBI.
BACKGROUNDS: After traumatic brain injury (TBI), hemorrhagic progression of contusions (HPCs) occurs frequently. However, there is no established predictive score to identify high-risk patients for HPC. METHODS: Consecutive patients who were hospitalized (2008-2013) with non-penetrating moderate or severe TBI were studied. The primary outcome was HPC, defined by both a relative increase in contusion volume by ≥30 % and an absolute increase by ≥10 mL on serial imaging. Logistic regression models were created to identify independent risk factors for HPC. The HPC Score was then derived based on the final model. RESULTS: Among a total of 286 eligible patients, 61 (21 %) patients developed HPC. On univariate analyses, HPC was associated with older age, higher initial blood pressure, antiplatelet medications, anticoagulants, subarachnoid hemorrhage (SAH) subdural hematoma (SDH), skull fracture, frontal contusion, larger contusion volume, and shorter interval from injury to initial CT. In the final model, SAH (OR 6.33, 95 % CI, 1.80-22.23), SDH (OR 3.46, 95 % CI, 1.39-8.63), and skull fracture (OR 2.67, 95 % CI, 1.28-5.58) were associated with HPC. Based on these factors, the HPC Score was derived (SAH = 2 points, SDH = 1 point, and skull fracture = 1 point). This score had an area under the receiver operating curve of 0.77. Patients with a score of 0-2 had a 4.0 % incidence of HPC, while patients with a score of 3-4 had a 34.6 % incidence of HPC. CONCLUSIONS: A simple HPC Score was developed for early risk stratification of HPC in patients with moderate or severe TBI.
Authors: Raj K Narayan; Andrew I R Maas; Franco Servadei; Brett E Skolnick; Michael N Tillinger; Lawrence F Marshall Journal: J Neurotrauma Date: 2008-06 Impact factor: 5.269