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Patient Outcomes in Traumatic Subarachnoid Hemorrhage: A Retrospective Analysis
Mark Broadwin1, Puja Patel1, Tara Stansbury2
1Lehigh Valley Health Network General Surgery Residency Program, Allentown, Pennsylvania.
The Journal of Surgical Research
|September 18, 2023
Summary
Patients with isolated traumatic subarachnoid hemorrhage (itSAH) and high Glasgow Coma Scale (GCS) scores may not require neurosurgical evaluation. Identifying specific patient factors can help determine the need for transfer and intensive care, optimizing management strategies.
Area of Science:
- Neurosurgery
- Trauma Care
- Radiology
Background:
- Isolated traumatic subarachnoid hemorrhage (itSAH) often leads to transfer to specialized trauma centers for neurosurgical evaluation.
- Recent literature suggests that some itSAH patients with high Glasgow Coma Scale (GCS) scores might be safely managed without neurosurgical consultation.
Purpose of the Study:
- To investigate the characteristics of patients with itSAH.
- To determine the clinical utility of neurosurgical evaluation and repeat imaging in itSAH patients.
- To identify factors associated with worsening conditions in itSAH patients.
Main Methods:
- Retrospective chart review of 350 adult patients with itSAH and initial GCS scores of 13-15.
- Analysis of patient demographics, medical history, injury details, and computed tomography head (CTH) results.
- Bivariate analyses to identify factors associated with worsening repeat CTH findings.
Main Results:
- The majority of patients were female (57.4%) with blunt injuries (99.1%); median age was 73.
- Neurosurgical consultation was obtained for 97.7% of patients, with only 0.3% requiring intervention.
- Worsening CTH was observed in 5.1% of repeat imaging, associated with injury severity, neurological deficit, length of stay, and comorbidities like heart failure, cirrhosis, or substance use disorder.
Conclusions:
- Patients with itSAH and high GCS scores may be managed safely without routine neurosurgical oversight.
- Specific patient factors identified can aid in selecting patients requiring transfer for intensive care.
- Further research is necessary to validate these findings and refine management protocols for itSAH.
