Traumatic brain injury and intraparenchymal hemorrhage progression: Blood pressure variability matters

Blood pressure variability (BPV) has been shown to correlate with intraparenchymal hematoma progression (HP) and worse outcomes in patients with spontaneous intracerebral hemorrhage (sICH). However, this association has not been elucidated in patients with traumatic intraparenchymal hemorrhage or contusion (tIPH). We hypothesized that 24 h-BPV from time of admission is associated with hemorrhagic progression of contusion or intraparenchymal hemorrhage (HPC), and worse outcomes in patients with tIPH.

We performed a retrospective observational analysis of adult patients treated at an academic regional Level 1 trauma center between 01/2018-12/2019. We included patients who had tIPH and ≥ 2 computer tomography (CT) scans within 24 h of admission. HP, defined as ≥30% of admission hematoma volume, was calculated by the ABC/2 method. We performed stepwise multivariable logistic regressions for the association between clinical factors and outcomes.

We analyzed 354 patients' charts. Mean age (Standard Deviation [SD]) was 56 (SD = 21) years, 260 (73%) were male. Mean admission hematoma volume was 7 (SD =19) cubic centimeters (cm³), 160 (45%) had HP. Coefficient of variation in systolic blood pressure (SBP_CV) (OR 1.03, 95%CI 1.02-1.3, p = 0.026) was significantly associated with HPC among patients requiring external ventricular drain (EVD). Difference between highest and lowest systolic blood pressure (SBP_max-min) (OR 1.02, 95%CI 1.004-1.03, p = 0.007) was associated with hospital mortality.

SBP_CV was significantly associated with HP among patients who required EVD. Additionally, increased SBP_max-min was associated with an increase in mortality. Clinicians should be cautious with patients' blood pressure until further studies confirm these observations.