Hemorrhagic Progression of Contusion in Patients with Mild Traumatic Brain Injury on the Routine Repeat Head Computed Tomography (original) (raw)
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Traumatic Brain Injury and its Findings on Computed Tomography; A Tertiary Care Hospital Experience
Introduction: Traumatic brain injury (TBI), a form of acquired brain injury, occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. It remains the most common cause of death following trauma, with particularly high mortality and morbidity in low and middle-income countries (LMIC) like Bangladesh. Aim of the study: The aim of the study was to evaluate the frequency of traumatic brain injury (TBI) on computed tomography in Bangabandhu Sheikh Mujib Medical College (BSMMC), Faridpur, Bangladesh. Methods: It is a retrospective cross-sectional study, a total of 147 patients had head injuries who were admitted to the Department of Radiology and Imaging from January 2021 to December 2021 in Bangabandhu Sheikh Mujib Medical College (BSMMC), Faridpur, Bangladesh. Patients included in this study were those who met the inclusion criteria. Data was collected from emergency departments with consent. Result: A total of 147 patients were enrolled and analyzed in this retrospective cross-sectional study. In this study, most of the 55(37.41%) patients were from the age group 1-14 years and only 12(8.16%) patients were aged above 65 years. According to the CT scan finding, 82% of patients had a scalp hematoma, 65(44.22%) patients had normal pain, almost 30% of patients had skull fractures and only 4% of patients had inflammatory changes. In this study, 94(63.95%) patients fell from height and 53(36.05%) patients had an accidental case. Conclusion: In conclusion, the prevalence of percentage of non-hemorrhage contusions and extradural hematoma have almost an equivalent frequency. Males have a higher rate of intracranial hemorrhage than females. Patients who have been in road traffic accidents \have a higher risk of developing a scalp hematoma than those who have had other types of traumatic injuries.
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, 2020
Introduction: Traumatic cerebral contusion is one of the leading cause of morbidity and mortality in Neurosurgery. Patients can be either treated conservatively or surgically. Many patients who are treated conservatively may have CT scan progression and need surgery secondarily. This retrospective study was designed to study the clinical presentation and interventions predicting CT progression of hematoma and final outcome. Material and Methods: The study was conducted from April 2017 to December 2019 on all the patients of traumatic cerebral contusions, diagnosed by CT scan. Patients received either conservative treatment initially or underwent upfront surgery, and had at least one other CT scan during the acute hospitalization. Patients clinical history, CT progression and any intervention were noted. The patient’s disposition status was classified as discharged home, or to another institution, or whether the patient died. Results: Among the total 448 patients, 78.5% patients requ...
EAS Journal of Radiology and Imaging Technology, 2021
Background: Traumatic brain injury and its implications lead to huge public health issues. Annually, TBI affects approximately 50 million individuals all around the world. Head injury is the leading neurological reason for despondency and fatality, particularly influencing the youngsters. 85% to 90% are mild or moderate TBI. Objective: To find prevalence of traumatic brain injuries on computed tomography and that of severity classification from mild to severe grade. Material and Methods: 100 patients with history of head trauma were evaluated in this study, which came to emergency department of Public sector. GCS was taken and all were referred to CT. Noncontrast CT of brain was performed with slice thickness of 3mm from skull base to vertex. And analysis was done using (SPSS) Statistical Package for the Social Sciences version 21. Results: Of 100 TBI patients, men composed 66% and women 34%. Falls (38%), violence (2%) and other causes (5%) all collectively cause fewer traumas than RTA (55%) specifically in patients of age group 16-26 years. Different traumatic brain injuries were noted including EDH (22%), IPH (23%), SAH (9%), SDH (27%), Contusion (4%) and infarction (15%). Noteworthy, most of the brain injuries were observed as mild TBI in 65% of cases accounting for more than moderate (21%) and severe TBI (14%). Conclusion: The study concludes that 65% of patients who acquired head trauma had mild TBI while remaining 21% and 14% consumed moderate and severe TBI respectively. Subdural and intraparenchymal hemorrhages are most frequent type of diagnosis in TBI.
Turkish Neurosurgery, 2010
AIm: In recent decades, considerable progress has been made in diagnosis and management of cranial trauma patients. Computed Tomography has resulted in a revolution in head injury diagnosis, making it possible to detect cases suitable for surgical treatment in a rapid, non-invasive manner. We present our experience in treating patients with head injuries at Emergency Department by describing the process and the criteria under which any diagnostic test is performed focusing in CT head scan. mAterIAl and methOds: Between 2007-2009 we studied 1356 adult patients (725 male and 631 female) who came at the emergency department claiming head injury. The factors registered were the mechanism of injury, the neurological evaluation, the Glasgow Coma Scale (GCS), the specialty of the doctor who made the first evaluation, and finally in which cases and with which criteria the CT scan was performed. results: Only a disproportionate small number of the patients who arrive at the emergency room claiming head injury require neurosurgical intervention (4.8% in our study). The majority of the CT scans who are performed as emergency procedure have no pathological findings (53.4%). COnClusIOn: The general surgeon with the appropriate education is able to evaluate the patients with head injury.
Journal of the American College of Surgeons, 2014
BACKGROUND: A definitive consensus on the standardization of practice of a routine repeat head CT (RHCT) scan in patients with traumatic intracranial hemorrhage is lacking. We hypothesized that in examinable patients without neurologic deterioration, RHCT scan does not lead to neurosurgical intervention (craniotomy/craniectomy). STUDY DESIGN: This was a 3-year prospective cohort analysis of patients aged 18 years and older, without antiplatelet or anticoagulation therapy, presenting to our level 1 trauma center with intracranial hemorrhage on initial head CT and a follow-up RHCT. Neurosurgical intervention was defined by craniotomy/craniectomy. Neurologic deterioration was defined as altered mental status, focal neurologic deficits, and/or pupillary changes. RESULTS: A total of 1,129 patients were included. Routine RHCT was performed in 1,099 patients. The progression rate was 19.7% (216 of 1,099), with subsequent neurosurgical intervention in 4 patients. Four patients had an abnormal neurologic examination, with a Glasgow Coma Scale (GCS) of 8 requiring intubation. Thirty patients had an RHCT secondary to neurologic deterioration; 53% (16 of 30) had progression on RHCT, of which 75% (12 of 16) required neurosurgical intervention. There was an association between deterioration in neurologic examination and need for neurosurgical intervention (odds ratio 3.98; 95% CI 1.7 to 9.1). The negative predictive value of a deteriorating neurologic examination in predicting the need for neurosurgical intervention was 100% in patients with GCS > 8. CONCLUSIONS: Routine repeat head CT scan is not warranted in patients with normal neurologic examination. Routine repeat head CT scan does not supplement the need for neurologic examination for determining management in patients with traumatic brain injury.
The purpose of this prospective study over 100 patients who were admitted to surgical emergency unit was to define the indications, the timing and the frequency of repeated head computerized tomography (CT) scan in patients with moderate and severe traumatic brain injuries (TBIs) and to verify its impact on the management of those patients. we found that Performing an initial early CT brain within 2 hours interval from onset of trauma had a significance in comparison to 4 hours and 6 hours interval, none of the follow up CTs done upon improvement of GCS show any changes, more than half of patients who show new changes or progression of lesions in their follow up CT did it due to deteriorated GCS, the follow up CT done routinely showed progression or new changes in around 70 % of the patients and affected the management in 60% of patients, the majority of the follow up CT at which medical management was done (n=40) was arranged at 12 hours interval from the initial CT done (30%) followed by those arranged at 6 hours (25%) and at 4 hours (22%), while follow up CT at which surgical intervention was done (n=21) was those arranged at 4 hours interval from the initial CT done (28%) followed by those arranged at 12 hours (24%) and 24 hours (24%).
Computed tomography and clinical outcome in patients with severe traumatic brain injury
Brain injury, 2017
To study: (i) acute computed tomography (CT) characteristics and clinical outcome; (ii) clinical course and (iii) Corticosteroid Randomisation after Significant Head Injury acute calculator protocol (CRASH) model and clinical outcome in patients with severe traumatic brain injury (sTBI). Initial CT (CTi) and CT 24 hours post-trauma (CT24) were evaluated according to Marshall and Rotterdam classifications. Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) and Glasgow Outcome Scale Extended (GOSE) were assessed at three months and one year post-trauma. The prognostic value of the CRASH model was evaluated. Thirty-seven patients were included. Marshall CTi and CT24 were significantly correlated with RLAS-R at three months. Rotterdam CT24 was significantly correlated with GOSE at three months. RLAS-R and the GOSE improved significantly from three months to one year. CRASH predicted unfavourable outcome at six months for 81% of patients with bad outcome and for 85% of patients with favo...
JAMA Neurology
IMPORTANCE A head computed tomography (CT) with positive results for acute intracranial hemorrhage is the gold-standard diagnostic biomarker for acute traumatic brain injury (TBI). In moderate to severe TBI (Glasgow Coma Scale [GCS] scores 3-12), some CT features have been shown to be associated with outcomes. In mild TBI (mTBI; GCS scores 13-15), distribution and co-occurrence of pathological CT features and their prognostic importance are not well understood. OBJECTIVE To identify pathological CT features associated with adverse outcomes after mTBI. DESIGN, SETTING, AND PARTICIPANTS The longitudinal, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study enrolled patients with TBI, including those 17 years and older with GCS scores of 13 to 15 who presented to emergency departments at 18 US level 1 trauma centers between February 26, 2014, and August 8, 2018, and underwent head CT imaging within 24 hours of TBI. Evaluations of CT imaging used TBI Common Data Elements. Glasgow Outcome Scale-Extended (GOSE) scores were assessed at 2 weeks and 3, 6, and 12 months postinjury. External validation of results was performed via the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Data analyses were completed from February 2020 to February 2021. EXPOSURES Acute nonpenetrating head trauma. MAIN OUTCOMES AND MEASURES Frequency, co-occurrence, and clustering of CT features; incomplete recovery (GOSE scores <8 vs 8); and an unfavorable outcome (GOSE scores <5 vs Ն5) at 2 weeks and 3, 6, and 12 months. RESULTS In 1935 patients with mTBI (mean [SD] age, 41.5 [17.6] years; 1286 men [66.5%]) in the TRACK-TBI cohort and 2594 patients with mTBI (mean [SD] age, 51.8 [20.3] years; 1658 men [63.9%]) in an external validation cohort, hierarchical cluster analysis identified 3 major clusters of CT features: contusion, subarachnoid hemorrhage, and/or subdural hematoma; intraventricular and/or petechial hemorrhage; and epidural hematoma. Contusion, subarachnoid hemorrhage, and/or subdural hematoma features were associated with incomplete recovery (odds ratios [ORs] for GOSE scores <8 at 1 year: TRACK-TBI, 1.80 [95% CI, 1.39-2.33]; CENTER-TBI, 2.73 [95% CI, 2.18-3.41]) and greater degrees of unfavorable outcomes (ORs for GOSE scores <5 at 1 year: TRACK-TBI, 3.23 [95% CI, 1.59-6.58]; CENTER-TBI, 1.68 [95% CI, 1.13-2.49]) out to 12 months after injury, but epidural hematoma was not. Intraventricular and/or petechial hemorrhage was associated with greater degrees of unfavorable outcomes up to 12 months after injury (eg, OR for GOSE scores <5 at 1 year in TRACK-TBI: 3.47 [95% CI, 1.66-7.26]). Some CT features were more strongly associated with outcomes than previously validated variables (eg, ORs for GOSE scores <5 at 1 year in TRACK-TBI: neuropsychiatric history, 1.43 [95% CI .98-2.10] vs contusion, subarachnoid hemorrhage, and/or subdural hematoma, 3.23 [95% CI 1.59-6.58]). Findings were externally validated in 2594 patients with mTBI enrolled in the CENTER-TBI study. CONCLUSIONS AND RELEVANCE In this study, pathological CT features carried different prognostic implications after mTBI to 1 year postinjury. Some patterns of injury were associated with worse outcomes than others. These results support that patients with mTBI and these CT features need TBI-specific education and systematic follow-up.