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Predicting mortality in traumatic intracranial hemorrhage.

Andrew Y Powers1, Mauricio B Pinto1, Oliver Y Tang1

  • 11Department of Neurosurgery, Warren Alpert Medical School of Brown University.

Journal of Neurosurgery
|February 24, 2019
PubMed
Summary

A new risk stratification model accurately predicts mortality in traumatic intracranial hemorrhage (tICH) patients. This tool aids in resource allocation and clinical decision-making for tICH outcomes.

Keywords:
CRASH = corticosteroid randomisation after significant head injuryGCS = Glasgow Coma ScaleIMPACT = International Mission for Prognosis and Analysis of Clinical Trials in TBIISS = Injury Severity ScoreTBI = traumatic brain injuryrisk stratificationtICH = traumatic intracranial hemorrhagetraumatraumatic brain injurytraumatic intracranial hemorrhage

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Area of Science:

  • Neurosurgery
  • Trauma Surgery
  • Critical Care Medicine

Background:

  • Traumatic intracranial hemorrhage (tICH) is a major cause of death and disability in trauma patients.
  • Existing prognostic models for tICH have limitations in accuracy, generalizability, and practicality.
  • There is a need for a simpler, more accurate risk stratification method for tICH patients.

Purpose of the Study:

  • To develop a simpler and more accurate risk stratification model for all traumatic intracranial hemorrhage patients.
  • To improve the identification of high-risk tICH patients.
  • To aid in clinical decision-making and resource allocation for tICH management.

Main Methods:

  • Retrospective analysis of 3564 tICH patients from a level 1 trauma center (2003-2013).
  • Collected data included demographics, vital signs, GCS, ISS, and hemorrhage type.
  • K-fold cross-validation and Akaike Information Criterion were used to develop and select the best risk stratification models.

Main Results:

  • The developed model demonstrated good calibration (p < 0.001) and high concordance (0.881).
  • Factors associated with increased mortality included older age, lower blood alcohol concentration, antiplatelet/anticoagulant use, lower GCS, and higher ISS.
  • Successful risk stratification was achieved across various hemorrhage subtypes.

Conclusions:

  • A novel, accurate, and well-calibrated risk stratification model for tICH was developed.
  • The model is applicable to multiple hemorrhage subtypes and can assist in resource allocation and clinical decision-making.
  • Future research will focus on external validation and the creation of a simplified, mentally calculable version of the model.