Abstract
Background
The presence of traumatic intraventricular hemorrhage (tIVH) following traumatic brain injury (TBI) is associated with worse neurological outcome. The mechanisms by which patients with tIVH have worse outcome are not fully understood and research is ongoing, but foundational studies that explore prognostic factors within tIVH populations are also lacking. This study aimed to further identify and characterize demographic and clinical variables within a subset of patients with TBI and tIVH that may be implicated in tIVH outcome.
Methods
In this observational study, we reviewed a large prospective TBI database to determine variables present on admission that predicted neurological outcome 6 months after injury. A review of 7,129 patients revealed 211 patients with tIVH on admission and 6-month outcome data. Hypothesized risk factors were tested in univariate analyses with significant variables (p < 0.05) included in logistic and linear regression models. Following the addition of either the Rotterdam computed tomography or Glasgow Coma Scale (GCS) score, we employed a backward selection process to determine significant variables in each multivariate model.
Results
Our study found that that hypotension (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.13–0.94, p = 0.04) and the hemoglobin level (OR = 1.33, 95% CI = 1.09–1.63, p = 0.006) were significant predictors in the Rotterdam model, whereas only the hemoglobin level (OR = 1.29, 95% CI = 1.06–1.56, p = 0.01) was a significant predictor in the GCS model.
Conclusions
This study represents one of the largest investigations into prognostic factors for patients with tIVH and demonstrates that admission hemoglobin level and hypotension are associated with outcomes in this patient population. These findings add value to established prognostic scales, could inform future predictive modeling studies, and may provide potential direction in early medical management of patients with tIVH.
Similar content being viewed by others
References
Centers for Disease Control and Prevention. Surveillance report of traumatic brain injury-related emergency department visits, hospitalizations, and deaths–United States, 2014. Atlanta, Georgia: U.S.; 2019.
Abraszko RA, Zurynski YA, Dorsch NW. The significance of traumatic intraventricular haemorrhage in severe head injury. Br J Neurosurg. 1995;9:769–73.
Cordobés F, de la Fuente M, Lobato RD, et al. Intraventricular hemorrhage in severe head injury. J Neurosurg. 1983;58:217–22.
Haydel MJ, Burns B. Blunt Head Trauma. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2021.
Mizuno M, Kurimoto T, Yamanouchi Y, Someda K, Matsumura H. Traumatic intraventricular haemorrhage. Factors affecting outcome in 22 cases. Neurol Med Chir (Tokyo). 1988;28:380–6.
Kim HJ, Pyen JS, Hu C, Hong SK, Kim HJ, Han YP. Traumatic intraventricular hemorrhage (TIVH). J Korean Neurosurg Soc. 1996;25:388–93.
Atzema C, Mower WR, Hoffman JR, Holmes JF, Killian AJ, Wolfson AB. Prevalence and prognosis of traumatic intraventricular hemorrhage in patients with blunt head trauma. J Trauma. 2006;60:1010–7.
Cucchiara BL, Kasner SE, Goddeau RP. UpToDate. Intraventricular hemorrhage. 2021. https://www.uptodate.com/contents/intraventricular-hemorrhage
Shibahashi K, Sugiyama K, Okura Y, Hoda H, Hamabe Y. Intraventricular hemorrhage after head injury: a multicenter, retrospective. Cohort Study World Neurosurg. 2018;114:e350-5.
Laleva M, Gabrovsky N, Naseva E, Velinov N, Gabrovsky S. Delayed intraventricular hemorrhage in moderate-to-severe traumatic brain injury: prevalence, associated risk factors, and prognosis. Acta Neurochir (Wien). 2016;158:1465–72.
Lee JP, Lui TN, Chang CN. Acute post-traumatic intraventricular hemorrhage analysis of 25 patients with emphasis on final outcome. Acta Neurol Scand. 1991;84:85–90.
Nguyen HS, Doan N, Gelsomino M, Shabani S. Patients with blunt traumatic brain injury: A role for computed tomography angiography of the head to evaluate nontraumatic causes? World Neurosurg. 2017;101:506–8.
Maas AIR, Hukkelhoven CW, Marshall LF, Steyerberg EW. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery. 2005;57:1173–82.
LeRoux PD, Haglund MM, Newell DW, Grady MS, Winn HR. Intraventricular hemorrhage in blunt head trauma: an analysis of 43 cases. Neurosurgery. 1992;31:678–85.
Biffi A, Battey TWK, Ayres AM, et al. Warfarin-related intraventricular hemorrhage: imaging and outcome. Neurology. 2011;77:1840–6.
Mushkudiani NA, Engel DC, Steyerberg EW, et al. Prognostic value of demographic characteristics in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007;24:259–69.
Butcher I, Maas AIR, Lu J, et al. Prognostic value of admission blood pressure in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007;24:294–302.
Van Beek JGM, Mushkudiani NA, Steyerberg EW, et al. Prognostic value of admission laboratory parameters in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007;24(2):315–28. https://doi.org/10.1089/neu.2006.0034.
Lavoie A, Ratte S, Clas D, et al. Preinjury warfarin use among elderly patients with closed head injuries in a trauma center. J Trauma. 2004;56:802–7.
Harrois A, Anstey JR, van der Jagt M, et al. Variability in serum sodium concentration and prognostic significance in severe traumatic brain injury: a multicenter observational study. Neurocrit Care. 2021;34:899–907.
Pegoli M, Zurlo Z, Bilotta F. Temperature management in acute brain injury: a systematic review of clinical evidence. Clin Neurol Neurosurg. 2020;197:106165.
Ziai WC, Muschelli J, Thompson CB, et al. Factors affecting clot lysis rates in patients with spontaneous intraventricular hemorrhage. Stroke. 2012;43:1234–9.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.
Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208.
Jayakumar PN, Kolluri VR, Basavakumar DG, Arya BY, Das BS. Prognosis in traumatic intraventricular haemorrhage. Acta Neurochir (Wien). 1990;106:48–51.
Flint AC, Manley GT, Gean AD, Hemphill JC, Rosenthal G. Post-operative expansion of hemorrhagic contusions after unilateral decompressive hemicraniectomy in severe traumatic brain injury. J Neurotrauma. 2008;25:503–12.
Munivenkatappa A, Agrawal A, Shukla DP, Kumaraswamy D, Devi BI. Traumatic brain injury: Does gender influence outcomes? Int J Crit Illn Inj Sci. 2016;6:70–3.
Farace E, Alves WM. Do women fare worse: a metaanalysis of gender differences in traumatic brain injury outcome. J Neurosurg. 2000;93:539–45.
Sigurdardottir S, Andelic N, Roe C, Schanke A. Cognitive recovery and predictors of functional outcome 1 year after traumatic brain injury. J Int Neuropsychol Soc. 2009;15:740–50.
Mathias JL, Wheaton P. Contribution of brain or biological reserve and cognitive or neural reserve to outcome after TBI: a meta-analysis (prior to 2015). Neurosci Biobehav Rev. 2015;55:573–93.
Shin M, Sohn MK, Lee J, et al. Effect of cognitive reserve on risk of cognitive impairment and recovery after stroke: the KOSCO study. Stroke. 2020;51:99–107.
Weir J, Steyerberg EW, Butcher I, et al. Does the extended glasgow outcome scale add value to the conventional glasgow outcome scale? J Neurotrauma. 2012;29:53–8.
Fujitsu K, Kuwabara T, Muramoto M, Hirata K, Mochimatsu Y. Traumatic intraventricular hemorrhage: report of twenty-six cases and consideration of the pathogenic mechanism. Neurosurgery. 1988;23:423–30.
Demetriades D, Kuncir E, Velmahos GC, Rhee P, Alo K, Chan LS. Outcome and prognostic factors in head injuries with an admission Glasgow Coma Scale score of 3. Arch Surg. 2004;139:1066–8.
Siegel JH. The effect of associated injuries, blood loss, and oxygen debt on death and disability in blunt traumatic brain injury: the need for early physiologic predictors of severity. J Neurotrauma. 1995;12:579–90.
Narayan RK, Greenberg RP, Miller JD, et al. Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure. J Neurosurg. 1981;54:751–62.
Fujimoto K, Miura M, Otsuka T, Kuratsu J. Sequential changes in Rotterdam CT scores related to outcomes for patients with traumatic brain injury who undergo decompressive craniectomy. J Neurosurg. 2016;124:1640–5.
Duane TM, Mayglothling J, Grandhi R, et al. The effect of anemia and blood transfusions on mortality in closed head injury patients. J Surg Res. 2008;147:163–7.
Steyerberg EW, Mushkudiani N, Perel P, et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med. 2008;5:e165.
Sekhon MS, McLean N, Henderson WR, Chittock DR, Griesdale DEG. Association of hemoglobin concentration and mortality in critically ill patients with severe traumatic brain injury. Crit Care. 2012;16:R128.
Yang C, Hsiao K, Su I, Chen I. The association between anemia and the mortality of severe traumatic brain injury in emergency department. J Trauma. 2011;71:132.
Oddo M, Levine JM, Kumar M, et al. Anemia and brain oxygen after severe traumatic brain injury. Intensive Care Med. 2012;38:1497–504.
Jeremitsky E, Omert L, Dunham CM, Protetch J, Rodriguez A. Harbingers of poor outcome the day after severe brain injury: hypothermia, hypoxia, and hypoperfusion. J Trauma. 2003;54:312–9.
Fearnside MR, Cook RJ, McDougall P, McNeil RJ. The westmead head injury project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables. Br J Neurosurg. 1993;7:267–79.
Marion DW, Carlier PM. Problems with initial Glasgow Coma Scale assessment caused by prehospital treatment of patients with head injuries: results of a national survey. J Trauma. 1994;36:89–95.
Chesnut RM, Marshall SB, Piek J, Blunt BA, Klauber MR, Marshall LF. Early and late systemic hypotension as a frequent and fundamental source of cerebral ischemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir Suppl (Wien). 1993;59:121–5.
Spaite DW, Hu C, Bobrow BJ, et al. Mortality and prehospital blood pressure in patients with major traumatic brain injury: implications for the hypotension threshold. JAMA Surg. 2017;152:360–8.
Manley G, Knudson MM, Morabito D, Damron S, Erickson V, Pitts L. Hypotension, hypoxia, and head injury: frequency, duration, and consequences. Arch Surg. 2001;136:1118–23.
Wijayatilake DS, Jigajinni SV, Sherren PB. Traumatic brain injury: physiological targets for clinical practice in the prehospital setting and on the Neuro-ICU. Curr Opin Anaesthesiol. 2015;28:517–24.
Sharma D, Brown MJ, Curry P, Noda S, Chesnut RM, Vavilala MS. Prevalence and risk factors for intraoperative hypotension during craniotomy for traumatic brain injury. J Neurosurg Anesthesiol. 2012;24:178–84.
Spaite DW, Bobrow BJ, Keim SM, et al. Association of statewide implementation of the prehospital traumatic brain injury treatment guidelines with patient survival following traumatic brain injury: the excellence in prehospital injury care (EPIC) study. JAMA Surg. 2019;154:e191152.
Li C, Chuang C, Chen C, et al. The role of intraventricular hemorrhage in traumatic brain injury: a novel scoring system. J Clin Med. 2022;11(8):2127.
Hallevi H, Dar NS, Barreto AD, et al. The IVH Score: a novel tool for estimating intraventricular hemorrhage volume: clinical and research implications*. Crit Care Med. 2009;37:969.
Funding
This work was supported by capstone project funding from the Frank H. Netter M.D. School of Medicine at Quinnipiac University.
Author information
Authors and Affiliations
Contributions
AKScurfield: conceptualization, investigation, original draft preparation, visualization, funding acquisition. MDW: methodology, formal analysis, review and editing. GG: conceptualization, review and editing, supervision. RM: writing, review and editing. KS: conceptualization, data analysis/interpretation, writing, review and editing, supervision, project administration.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical approval
For this type of study, formal consent was not required. The study was deemed exempt from institutional review board review by the University of California, Davis Institutional Review Board administration.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Scurfield, A.K., Wilson, M.D., Gurkoff, G. et al. Identification of Demographic and Clinical Prognostic Factors in Traumatic Intraventricular Hemorrhage. Neurocrit Care 38, 149–157 (2023). https://doi.org/10.1007/s12028-022-01587-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12028-022-01587-z