Prognosis analysis and risk factors related to progressive intracranial haemorrhage in patients with acute traumatic brain injury.
BACKGROUND
Since progressive intracranial haemorrhage (PIH) was introduced in neurosurgical literatures, several studies have been performed. PIH has been shown to be associated with a high increase in the risk of clinical worsening and related to morbidity and mortality as well. So, early detection and prediction of PIH is practically important in a clinical situation.


OBJECTIVE
To investigate the risk factors related to PIH in patients with acute traumatic brain injury (TBI) and analyse their clinical significances.


METHODS
PIH was confirmed by comparing the first and repeated CT scans. Data compared included gender, age, mechanism of injury, Glasgow Coma Score (GCS) at admission, timing from injury to the first CT, the signs of the initial CT scan, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fg), thrombin time (TT), platelet (PLT) and D-dimer (D-D) values. Logistic regression analysis was used to show the risk factors related to PIH.


RESULTS
A cohort of 498 patients with TBI was evaluated, and there were 139 (27.91%) patients who suffered from PIH. The differences between PIHs and non-PIHs were significant in age, GCS at admission, the signs of the initial CT scan (fracture, subarachnoid haemorrhage, brain contusion and primary haematoma), PT, Fg and D-D values (p < 0.001). Logistic regression analysis was used to identify that CT scans (subarachnoid haemorrhage, brain contusion and primary haematoma) and plasma D-D values as the most important predictors of PIH (p < 0.001).


CONCLUSIONS
For patients with the initial CT scan showing subarachnoid haemorrhage, brain contusion and primary haematoma with abnormal D-D levels, an earlier and dynamic CT scan should be performed, for the detection of PIH as early as possible and the medical intervention would be enforced in time.
Department of Neurosurgery, Pudong New Area People's Hospital, Shanghai, PR China. tongws001@yahoo.com.cn
Wu-Song
WS
Tong
Ping
P
Zheng
Jing-Song
JS
Zeng
Yi-Jun
YJ
Guo
Wen-Jin
WJ
Yang
Gao-Yi
GY
Li
Bin
B
He
Hui
H
Yu
Yong-Sheng
YS
Li
Xin-Fen
XF
Tang
Tong-Shun
TS
Lin
Jun-Fa
JF
Xu
D000328:Adult; D000368:Aged; D000933:Antifibrinolytic Agents / Q000494:pharmacology*; D001930:Brain Injuries / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000494:pharmacology*; D005340:Fibrinogen / Q000494:pharmacology*; D015600:Glasgow Coma Scale; D006801:Humans; D020300:Intracranial Hemorrhages / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013918:Thrombin Time / Q000379:methods; D014057:Tomography, X-Ray Computed
D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005340:Fibrinogen