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Risk Factors Associated With Neurosurgical Intervention in Patients With Mild Traumatic Intracranial Hemorrhage
Puja D Patel1, Mark Broadwin1, Tara Stansbury2
1Department of Surgery, Lehigh Valley Health Network/University of South Florida, Allentown, Pennsylvania.
The Journal of Surgical Research
|November 20, 2022
Summary
Identifying risk factors for neurosurgical intervention (NSI) in traumatic intracranial hemorrhage (ICH) can optimize patient transfers. Key indicators include male sex, warfarin use, subdural hemorrhage, and neurological deficits, guiding timely NSI for high-risk patients.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Emergency Medicine
Background:
- Traumatic intracranial hemorrhage (ICH) often leads to transfers to higher-level trauma centers for neurosurgical evaluation.
- Current transfer protocols may not adequately stratify risk, potentially leading to unnecessary transfers of low-risk patients or delayed care for high-risk individuals.
Purpose of the Study:
- To identify clinical factors and patient characteristics associated with the need for neurosurgical intervention (NSI) in patients with traumatic ICH.
- To potentially reduce unnecessary transfers and expedite care for patients requiring NSI.
Main Methods:
- Retrospective chart review of 1542 patients with traumatic ICH and Glasgow Coma Scale score 13-15.
- Analysis of initial head computerized tomography (CTH) scans, physical examinations, and patient demographics.
- Bivariate and multivariable regression analyses to determine factors predicting NSI.
Main Results:
- 8.2% of patients required NSI.
- Factors associated with NSI included male sex, warfarin use, subdural hemorrhage, larger subdural hemorrhage size, worsening repeat CTH, confusion, hemiparesis, and midline shift on CTH.
- Midline shift and its size were strongly associated with NSI.
Conclusions:
- Clinical factors and patient characteristics are significant predictors of the need for NSI in traumatic ICH.
- Identifying these risk factors can refine transfer criteria, reducing unnecessary transports and ensuring prompt intervention for high-risk patients.
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