J Korean Soc Traumatol.  2010 Dec;23(2):142-150.

Risk factors related to progressive traumatic intracerebral hematomas in the early post head injury period

• Lee YB
• Jeong HS

Abstract

PURPOSE
In this study, patients in whom two computed tomography (CT) scans had been obtained within 24 hours of injury were analyzed to determine the incidence, risk factors and clinical significance of a progressive intracerebral hematoma (PIH).
METHODS
Participants were 182 patients with a traumatic intracerebral hematoma and contusion who underwent a repeat CT scan within 24 hours of injury. Univarite and multivariate statistics were used to define growth (volume increase) and to examine the relationship between the risk factors and hemorrhage expansion.
RESULTS
Fifty-four percent of the patients experienced progression in the size of the lesion in the initial 24 hours postinjury. A PIH was independently associated with worsened Glasgow coma scale (GCS) score (2.99, 1.04~8.60), the presence of subarachnoid hemorrhage (6.29, 2.48~16.00), the presence of a subdural hematoma (6.18, 2.13~17.98), the presence of an epidural hematoma (5.73, 1.18~27.76), and the presence of a basal cistern effacement (10.93, 1.19~99.57).
CONCLUSION
For patients undergoing scanning within 2 hours of injury, the rate of PIH approaches 61%. Early repeated CT scanning is indicated in patients with a nonsurgically-treated hemorrhage revealed on the first CT scan. Worsened GCS score, significant hematoma growth and effacement of the basal cisterns on the initial CT scan are powerful predictors of which patients will require surgery. These findings should be important factors in understanding and managing of PIH.

Keyword

Computed tomography; Traumatic intracerebral hematoma; Risk factors; Progression

MeSH Terms

Contusions
Craniocerebral Trauma
Glasgow Coma Scale
Head
Hematoma
Hematoma, Subdural
Hemorrhage
Humans
Incidence
Risk Factors
Subarachnoid Hemorrhage