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Open Access 01-12-2016 | Research article

Risk factors for delayed neuro-surgical intervention in patients with acute mild traumatic brain injury and intracranial hemorrhage

Authors: Fu-Yuan Shih, Hsin-Huan Chang, Hung-Chen Wang, Tsung-Han Lee, Yu-Jun Lin, Wei-Che Lin, Wu-Fu Chen, Jih-Tsun Ho, Cheng-Hsien Lu

Published in: World Journal of Emergency Surgery | Issue 1/2016

Abstract

Background

Mild traumatic brain injury (TBI) patients with initial traumatic intracranial hemorrhage (tICH) and without immediate neuro-surgical intervention require close monitoring of their neurologic status. Progressive hemorrhage and neurologic deterioration may need delayed neuro-surgical intervention. This study aimed to determine the potential risk factors of delayed neuro-surgical intervention in mild TBI patients with tICH on admission.

Methods

Three hundred and forty patients with mild TBI and tICH who did not need immediate neuro-surgical intervention on admission were evaluated retrospectively. Their demographic information, clinical evaluation, laboratory data, and brain CT was reviewed. Delayed neuro-surgical intervention was defined as failure of non-operative management after initial evaluation. Risk factors of delayed neuro-surgical intervention on admission were analyzed.

Results

Delayed neuro-surgical intervention in mild TBI with tICH on initial brain CT accounted for 3.8 % (13/340) of all episodes. Higher WBC concentration, higher initial ISS, epidural hemorrhage (EDH), higher volume of EDH, midline shift, and skull fracture were risk factors of delayed neuro-surgical intervention. The volume of EDH and skull fracture is independent risk factors. One cubic centimeter (cm3) increase in EDH on initial brain CT increased the risk of delayed neurosurgical intervention by 16 % (p = 0.011; OR: 1.190, 95 % CI:1.041–1.362).

Conclusions

Mild TBI patients with larger volume of EDH have higher risk of delayed neuro-surgical interventions after neurosurgeon assessment. Longer and closer neurological function monitor and repeated brain image is required for those patients had initial larger EDH. A large-scale, multi-centric trial with a bigger study population should be performed to validate the findings.

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Title: Risk factors for delayed neuro-surgical intervention in patients with acute mild traumatic brain injury and intracranial hemorrhage
Authors: Fu-Yuan Shih
Hsin-Huan Chang
Hung-Chen Wang
Tsung-Han Lee
Yu-Jun Lin
Wei-Che Lin
Wu-Fu Chen
Jih-Tsun Ho
Cheng-Hsien Lu
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: World Journal of Emergency Surgery / Issue 1/2016
Electronic ISSN: 1749-7922
DOI: https://doi.org/10.1186/s13017-016-0069-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Risk factors for delayed neuro-surgical intervention in patients with acute mild traumatic brain injury and intracranial hemorrhage

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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