Predictive Factors for Traumatic Intraparenchymal Hemorrhage Expansion and Its Clinical Outcomes

Traumatic brain injury (TBI) remains a major public health issue, with intraparenchymal hemorrhage (IPH) contributing significantly to morbidity and mortality. While CT is central to initial diagnosis, the value of routine follow-up imaging for IPH remains uncertain. This study aimed to identify clinical and radiographic predictors of IPH enlargement and determine whether certain patients may be safely managed without repeat CT. Such a strategy could not only reduce avoidable imaging (and its associated radiation), but have implications for patient length of stay, impacting patient safety, care quality, costs, and hospital capacity.

We retrospectively reviewed all head NCCTs performed for trauma at 2 academic hospitals between July 2018 and May 2024. Reports were screened for acute IPH using defined search terms, and electronic medical records were reviewed for demographics, comorbidities, injury mechanism, imaging findings, management, and outcomes. Enlargement was defined as >1 mm increase in any dimension on follow-up CT. Associations were tested using univariate and multivariable analyses, including logistic regression.

Of the nearly 25,000 CT scans from patients with acute trauma, 239 patients were identified who had acute IPH. Older age, female sex, hypertension, and antithrombotic therapy were associated with larger baseline hematomas. Enlargement occurred in 30% of cases and was independently predicted by larger initial size (OR 1.02 per mm increase; P = .003) and concomitant SAH (OR 3.50; P = .002). Enlargement was associated with intensive care unit admission, surgical intervention, and increased mortality (25.8% versus 8.6%; P = .001). Patients with small isolated IPHs (<5 mm) did not demonstrate progression or require intervention.

Initial hematoma size and coexisting SAH strongly predict IPH growth. The rate of enlargement and the absence of intervention for small (<5 mm) isolated IPHs did not warrant follow-up imaging.