Radiological Parameters to Predict Hemorrhagic Progression of Traumatic Contusional Brain Injury

Traumatic intracerebral contusion is a frequent factor culminating in death and disability, and its progression relates to unfavorable outcome. We evaluated the radiological factors associated with hemorrhagic progression of contusions (HPC).

Two hundred and forty-six patients were enrolled in this prospective cohort over a period of 1 year. Contusion volume was quantified using the "ABC/2" technique, whereas progression was considered as >30% increase in the initial volume. Univariate and multivariate statistics were used to examine the correlation between the risk factors of interest and HPC.

HPC was seen in 110 (44.7%) patients. Binary logistic regression showed in the final adjusted model that multiplicity (relative risk [RR]: 2.24, 95% confidence limit [CL]: 1.00-5.48), bilateral lesions (RR: 2.99, 95% CL: 1.08-8.25), initial volume of contusion (RR: 4.96, 95% CL: 1.87-13.13), frontal location (RR: 1.42, 95% CL: 1.08-3.56), and presence of concomitant intracranial hematoma (extradural-RR: 3.90, 95% CL: 1.51-10.01, subdural-RR: 2.91, 95% CL: 1.26-6.69, and subarachnoid-RR: 2.27, 95% CL: 1.01-5.80) were significantly associated with HPC. The overall mortality was 18.7% and was almost equal among patients with and without HPC. Mortality was significantly associated with Glasgow Coma Scale on admission (adjusted RR: 12.386, 95% CL: 4.789-32.035) and presence of comorbid conditions (adjusted RR: 0.313, 95% CL: 0.114-0.860).

Initial computed tomography scan is a good predictor of high-risk group for HPC.