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Neurocritical Care
Published in: Neurocritical Care 1/2023

01-09-2022 | Central Nervous System Trauma | Original work

Identification of Demographic and Clinical Prognostic Factors in Traumatic Intraventricular Hemorrhage

Authors: Abby K. Scurfield, Machelle D. Wilson, Gene Gurkoff, Ryan Martin, Kiarash Shahlaie

Published in: Neurocritical Care | Issue 1/2023

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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.
Appendix
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Literature
1.
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.
2.
Abraszko RA, Zurynski YA, Dorsch NW. The significance of traumatic intraventricular haemorrhage in severe head injury. Br J Neurosurg. 1995;9:769–73.PubMedCrossRef
3.
Cordobés F, de la Fuente M, Lobato RD, et al. Intraventricular hemorrhage in severe head injury. J Neurosurg. 1983;58:217–22.PubMedCrossRef
4.
Haydel MJ, Burns B. Blunt Head Trauma. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2021.
5.
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.PubMedCrossRef
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.
7.
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.PubMedCrossRef
8.
9.
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.PubMedCrossRef
10.
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.PubMedCrossRef
11.
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.PubMedCrossRef
12.
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.PubMedCrossRef
13.
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.PubMedCrossRef
14.
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.PubMed
15.
16.
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.PubMedCrossRef
17.
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.PubMedCrossRef
18.
19.
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.PubMedCrossRef
20.
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.PubMedCrossRef
21.
Pegoli M, Zurlo Z, Bilotta F. Temperature management in acute brain injury: a systematic review of clinical evidence. Clin Neurol Neurosurg. 2020;197:106165.PubMedCrossRef
22.
Ziai WC, Muschelli J, Thompson CB, et al. Factors affecting clot lysis rates in patients with spontaneous intraventricular hemorrhage. Stroke. 2012;43:1234–9.PubMedPubMedCentralCrossRef
23.
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.PubMedCrossRef
24.
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.PubMedPubMedCentralCrossRef
25.
Jayakumar PN, Kolluri VR, Basavakumar DG, Arya BY, Das BS. Prognosis in traumatic intraventricular haemorrhage. Acta Neurochir (Wien). 1990;106:48–51.PubMedCrossRef
26.
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.PubMedCrossRef
27.
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.PubMedPubMedCentralCrossRef
28.
Farace E, Alves WM. Do women fare worse: a metaanalysis of gender differences in traumatic brain injury outcome. J Neurosurg. 2000;93:539–45.PubMedCrossRef
29.
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.PubMedCrossRef
30.
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.PubMedCrossRef
31.
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.PubMedCrossRef
32.
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.PubMedPubMedCentralCrossRef
33.
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.PubMedCrossRef
34.
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.PubMedCrossRef
35.
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.PubMedCrossRef
36.
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.PubMedCrossRef
37.
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.PubMedCrossRef
38.
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.PubMedCrossRef
39.
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.PubMedPubMedCentralCrossRef
40.
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.PubMedPubMedCentralCrossRef
41.
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.
42.
Oddo M, Levine JM, Kumar M, et al. Anemia and brain oxygen after severe traumatic brain injury. Intensive Care Med. 2012;38:1497–504.PubMedCrossRef
43.
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.PubMedCrossRef
44.
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.PubMedCrossRef
45.
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.PubMedCrossRef
46.
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.PubMed
47.
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.PubMedPubMedCentralCrossRef
48.
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.PubMedCrossRef
49.
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.PubMedCrossRef
50.
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.PubMedPubMedCentralCrossRef
51.
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.PubMedPubMedCentralCrossRef
52.
53.
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.PubMedPubMedCentralCrossRef
Metadata
Title
Identification of Demographic and Clinical Prognostic Factors in Traumatic Intraventricular Hemorrhage
Authors
Abby K. Scurfield
Machelle D. Wilson
Gene Gurkoff
Ryan Martin
Kiarash Shahlaie
Publication date
01-09-2022
Publisher
Springer US
Published in
Neurocritical Care / Issue 1/2023
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-022-01587-z

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