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Less is more: Streamlining management of isolated traumatic subarachnoid hemorrhage in the modified brain injury

Brandon A Bellen1, Janet S Lee1, Emily Johnson1

  • 1Department of Trauma and Acute Care Surgery, UCHealth Memorial Hospital, Colorado Springs, CO, USA; Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA.

American Journal of Surgery
|September 27, 2024
PubMed

Insights

Patients with isolated traumatic subarachnoid hemorrhage (iTSAH) did not require neurosurgical intervention, even with radiographic or neurologic progression. These findings suggest a potential revision of SAH definitions within the modified Brain Injury Guidelines (mBIG).

Area of Science:

  • Neurotrauma
  • Neurosurgery
  • Radiology

Background:

  • Isolated traumatic subarachnoid hemorrhage (iTSAH) management follows modified Brain Injury Guidelines (mBIG).
  • Current guidelines may not optimally stratify iTSAH patient risk.
  • Understanding iTSAH clinical trajectories is crucial for refining management protocols.

Purpose of the Study:

  • To describe patients diagnosed with iTSAH.
  • To analyze the clinical outcomes of patients with iTSAH.
  • To evaluate the necessity of neurosurgical consultation and repeat imaging in iTSAH.

Main Methods:

  • Retrospective analysis of trauma patients with iTSAH.
  • Exclusion of patients with Glasgow Coma Scale (GCS) < 13.
  • Exclusion of patients with pre-injury antiplatelet/anticoagulant use.

Main Results:

  • 276 patients with iTSAH were identified over an 8-year period.
  • 80.4% of patients received neurosurgery consultation.
  • Radiographic progression occurred in 8.6% and neurologic deterioration in 2.2% of patients, with no operative interventions or deaths related to iTSAH.

Conclusions:

  • No iTSAH patients required neurosurgical consultation despite radiographic or neurologic progression.
  • Repeat head CT scans and neurosurgical consults may not be necessary for all iTSAH patients.
  • The definition of SAH within the mBIG may require revision to better reflect iTSAH patient outcomes.
Abstract

Keywords:
Modified brain injury guidelinesSubarachnoid hemorrhageTraumatic brain injury

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