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. 2023 Feb 13;23(1):68.
doi: 10.1186/s12883-023-03112-x.

Classification, risk factors, and outcomes of patients with progressive hemorrhagic injury after traumatic brain injury

Ren Wang #  1 , Dian-Xu Yang #  1 , Jun Ding  1 , Yan Guo  1 , Wan-Hai Ding  1 , Heng-Li Tian  2 , Fang Yuan  3
Affiliations

Classification, risk factors, and outcomes of patients with progressive hemorrhagic injury after traumatic brain injury

Ren Wang et al. BMC Neurol. .

Abstract

Background: According to the pathoanatomic classification system, progressive hemorrhagic injury (PHI) can be categorized into progressive intraparenchymal contusion or hematoma (pIPCH), epidural hematoma (pEDH), subdural hematoma (pSDH), and traumatic subarachnoid hemorrhage (ptSAH). The clinical features of each type differ greatly. The objective of this study was to determine the predictors, clinical management, and outcomes of PHI according to this classification.

Methods: Multivariate logistic regression analysis was used to identify independent risk factors for PHI and each subgroup. Patients with IPCH or EDH were selected for subgroup propensity score matching (PSM) to exclude confounding factors before evaluating the association of hematoma progression with the outcomes by classification.

Results: In the present cohort of 419 patients, 123 (29.4%) demonstrated PHI by serial CT scan. Of them, progressive ICPH (58.5%) was the most common type, followed by pEDH (28.5%), pSDH (9.8%), and ptSAH (3.2%). Old age (≥ 60 years), lower motor Glasgow Coma Scale score, larger primary lesion volume, and higher level of D-dimer were independent risk factors related to PHI. These factors were also independent predictors for pIPCH, but not for pEDH. The time to first CT scan and presence of skull linear fracture were robust risk factors for pEDH. After PSM, the 6-month mortality and unfavorable survival rates were significantly higher in the pIPCH group than the non-pIPCH group (24.2% vs. 1.8% and 12.1% vs. 7.3%, respectively, p < 0.001), but not significantly different between the pEDH group and the non-pEDH group.

Conclusions: Understanding the specific patterns of PHI according to its classification can help early recognition and suggest targeted prevention or treatment strategies to improve patients' neurological outcomes.

Keywords: Classification; Progressive hemorrhagic injury; Traumatic brain injury; propensity score matching, outcomes.

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Conflict of interest statement

The authors declare no competing interests.

References

    1. Cepeda S, Gomez PA, Castano-Leon AM, Martinez-Perez R, Munarriz PM, Lagares A. Traumatic intracerebral hemorrhage: risk factors associated with progression. J Neurotrauma. 2015;32(16):1246–1253. doi: 10.1089/neu.2014.3808. - DOI - PubMed
    1. Wan X, Fan T, Wang S, Zhang S, Liu S, Yang H, et al. Progressive hemorrhagic injury in patients with traumatic intracerebral hemorrhage: characteristics, risk factors and impact on management. Acta Neurochir. 2017;159(2):227–235. doi: 10.1007/s00701-016-3043-6. - DOI - PubMed
    1. Yuan Q, Sun YR, Wu X, Yu J, Li ZQ, Du ZY, et al. Coagulopathy in traumatic brain injury and its correlation with progressive hemorrhagic injury: a systematic review and meta-analysis. J Neurotrauma. 2016;33(14):1279–1291. doi: 10.1089/neu.2015.4205. - DOI - PubMed
    1. Yuan F, Ding J, Chen H, Guo Y, Wang G, Gao WW, et al. Predicting progressive hemorrhagic injury after traumatic brain injury: derivation and validation of a risk score based on admission characteristics. J Neurotrauma. 2012;29(12):2137–2142. doi: 10.1089/neu.2011.2233. - DOI - PMC - PubMed
    1. Allison RZ, Nakagawa K, Hayashi M, Donovan DJ, Koenig MA. Derivation of a predictive score for hemorrhagic progression of cerebral contusions in moderate and severe traumatic brain injury. Neurocrit Care. 2017;26(1):80–86. doi: 10.1007/s12028-016-0303-5. - DOI - PMC - PubMed

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