Advertisement

Neuroradiology

, Volume 53, Issue 5, pp 305–309 | Cite as

Early CT signs of progressive hemorrhagic injury following acute traumatic brain injury

  • Wu-song Tong
  • Ping Zheng
  • Jun-fa Xu
  • Yi-jun Guo
  • Jing-song Zeng
  • Wen-jin Yang
  • Gao-yi Li
  • Bin He
  • Hui Yu
Diagnostic Neuroradiology

Abstract

Introduction

Since progressive hemorrhagic injury (PHI) was introduced in neurosurgical literatures, several studies have been performed, the results of which have influenced doctors but do not define guidelines for the best treatment of PHI. PHI may be confirmed by a serial computerized tomography (CT) scan, and it has been shown to be associated with a fivefold increase in the risk of clinical worsening and is a significant cause of morbidity and mortality as well. So, early detection of PHI is practically important in a clinical situation.

Methods

To analyze the early CT signs of progressive hemorrhagic injury following acute traumatic brain injury (TBI) and explore their clinical significances, PHI was confirmed by comparing the first and repeated CT scans. Data were analyzed and compared including times from injury to the first CT and signs of the early CT scan. Logistic regression analysis was used to show the risk factors related to PHI.

Results

A cohort of 630 TBI patients was evaluated, and there were 189 (30%) patients who suffered from PHI. For patients with their first CT scan obtained as early as 2 h post-injury, there were 116 (77.25%) cases who suffered from PHI. The differences between PHIs and non-PHIs were significant in the initial CT scans showing fracture, subarachnoid hemorrhage (SAH), brain contusion, epidural hematoma (EDH), subdural hematoma (SDH), and multiple hematoma as well as the times from injury to the first CT scan (P < 0.01). Logistic regression analysis showed that early CT scans (EDH, SDH, SAH, fracture, and brain contusion) were predictors of PHI (P < 0.01).

Conclusion

For patients with the first CT scan obtained as early as 2 h post-injury, a follow-up CT scan should be performed promptly. If the initial CT scan shows SAH, brain contusion, and primary hematoma with brain swelling, an earlier and dynamic CT scan should be performed for detection of PHI as early as possible and the medical intervention would be enforced in time.

Keywords

Traumatic brain injury (TBI) Progressive hemorrhagic injury (PHI) Early CT scan CT signs 

Notes

Conflict of interest statement

We declare that we have no conflict of interest.

References

  1. 1.
    Klauber MR, Marshall LF, Toole BM et al (1985) Cause of decline in head-injury mortality rate in San Diego County, California. J Neurosurg 62:528–531PubMedCrossRefGoogle Scholar
  2. 2.
    Shackford SR, Mackersie RC, Hoyt DB et al (1987) Impact of a trauma system on outcome of severely injured patients. Arch Surg 122:523–527PubMedGoogle Scholar
  3. 3.
    Perel P, Roberts I, Bouamra O et al (2009) Intracranial bleeding in patients with traumatic brain injury: a prognostic study. BMC Emerg Med 9:15PubMedCrossRefGoogle Scholar
  4. 4.
    Narayan RK, Mass AI, Servdei F et al (2007) Progression of traumatic intracerebral hemorrhage: a prospective observational study. J Neurotrauma 25:629–639CrossRefGoogle Scholar
  5. 5.
    Sanus GZ, Tanriverdi T, Alver H et al (2004) Evolving trauma brain lesions predictors and results of ninety-eight head-injured patients. Neurosurg Q 14(2):97–104CrossRefGoogle Scholar
  6. 6.
    Jiang JY, Zhu C, Luo QZ (3rd) (2008) Clinical guidelines for the management of head injury. Second Military University Shanghai, pp 1–227Google Scholar
  7. 7.
    Liang YM, Bao YH, Jiang JY (2006) Research progress in progressive hemorrhagic injury following head trauma. Chin J Trauma 22(2):l56–l159Google Scholar
  8. 8.
    Oertel M, Kelly DF, Mcarthur D et al (2002) Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. Neurosurgery 96(1):109–116CrossRefGoogle Scholar
  9. 9.
    Chang EF, Meeker M, Holland MC (2006) Acute traumatic intraparenchymal hemorrhage: risk factors for progression in the early post-injury period. Neurosurgery 58:647–656PubMedCrossRefGoogle Scholar
  10. 10.
    Stein SC, Spettell C, Young G et al (1993) Delayed and progressive brain injury in closed head trauma: radiological demonstration. Neurosurgery 33:25–31CrossRefGoogle Scholar
  11. 11.
    Servadei F, Nanni A, Nasi MT et al (1995) Evolving brain lesion in the first 12 hours after head injury: analysis of 37 comatose patients. Neurosurgery 37:899–911PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Wu-song Tong
    • 1
  • Ping Zheng
    • 1
  • Jun-fa Xu
    • 1
  • Yi-jun Guo
    • 1
  • Jing-song Zeng
    • 1
  • Wen-jin Yang
    • 1
  • Gao-yi Li
    • 1
  • Bin He
    • 1
  • Hui Yu
    • 1
  1. 1.Department of NeurosurgeryPudong New Area People’s HospitalShanghaiChina

Personalised recommendations