Predictors of radiological contusion progression in traumatic brain injury

Traumatic brain injury, mainly caused by the unintentional falls and motor vehicle accidents, is a serious condition encompassing a spectrum of pathological features from axonal to hemorrhagic injuries. Among these, cerebral contusions significantly contribute to death and disability following the injury and occur in up to 35% of cases. This study aimed to investigate the predictors of radiological contusion progression in traumatic brain injury.

We performed a retrospective cross-sectional study using the files of the patients with mild traumatic brain injury who had cerebral contusions from 21 March 2021 to 20 March 2022. The severity of brain injury was determined using the Glasgow Coma Score. Furthermore, we used a cut-off value of a 30% increase in contusion size in the secondary CT scans (up to 72 hours) compared to the first one to define the significant progression of the contusions. For the patients with multiple contusions, we measured the biggest contusion.

705 patients with traumatic brain injury were found, the severity of the injury was mild in 498 of them, and 218 had cerebral contusions. 131 (60.1%) patients were injured in vehicle accidents. 111 (50.9%) had significant contusion progression. Most patients were conservatively managed, but 21 out of them (10%) required delayed surgical intervention.

We found that the presence of subdural hematoma, subarachnoid hemorrhage, and epidural hematoma were predictors of radiological contusion progression, and the patients with a subdural hematoma and epidural hematoma were more likely to undergo surgery. In addition to providing prognostic information, predicting risk factors for the progression of the contusions is crucial for identifying patients who might benefit from surgical and critical care therapies.