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Updated: Nov 16, 2025

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Delayed intracranial hemorrhage after trauma.

Biswadev Mitra1,2,3, Tomi Ruggles4, Jarrel Seah5

  • 1Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia.

Brain Injury
|February 19, 2021
PubMed
Summary

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Delayed intracranial hemorrhage (D-ICH) is rare after normal head CT scans. This study found a low incidence of D-ICH, questioning the need for prolonged hospital observation solely for this complication.

Area of Science:

  • Neurology
  • Trauma Surgery
  • Radiology

Background:

  • Delayed intracranial hemorrhage (D-ICH) is a serious complication following head trauma.
  • D-ICH is defined as the appearance of intracranial hemorrhage on follow-up imaging after an initially normal brain computed tomography (CTB).

Purpose of the Study:

  • To determine the incidence and severity of D-ICH in patients presenting to a major trauma center.
  • To identify risk factors associated with D-ICH.

Main Methods:

  • Retrospective cohort study of 6536 patients with initial normal CTB from Jan 2013 to Dec 2018.
  • Analysis of patient demographics, clinical presentation (GCS), medication use (anti-platelets, anti-coagulants), and imaging findings.
  • Calculation of D-ICH incidence and odds ratios for associated factors.
Keywords:
Wound and injuriesbrain injuriescomputed tomographydelayedintracerebral hemorrhage

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Main Results:

  • The incidence of D-ICH was 0.3% (23/6536) in patients with an initial normal CTB.
  • In patients who underwent repeat CTB (n=653), the D-ICH incidence was 3.5%.
  • No significant association found with age >65, GCS <15, or anti-platelet use; however, anticoagulant use was associated with lower odds of D-ICH (OR 0.23). All D-ICH cases were Marshall classification type II, with no neurosurgical interventions or deaths.

Conclusions:

  • The overall incidence of D-ICH after a normal initial CTB is low.
  • Hospital observation solely to rule out D-ICH in asymptomatic patients with normal initial CTB may not be necessary.
  • Further research could refine observation protocols for head trauma patients.