title: The clinical significance of small subarachnoid hemorrhages.
abstract: With advancing technology, the sensitivity of computed tomography (CT) for the detection of traumatic subarachnoid hemorrhage (tSAH) continues to improve. Increased resolution has allowed for the detection of hemorrhage that is limited to one or two images of the CT exam. At our institution, all patients with a SAH require intensive care unit (ICU) admission, regardless of size. It was our hypothesis that patients with small subarachnoid hemorrhage experience favorable outcomes, and may not require the intensive monitoring offered in the ICU. This retrospective study evaluated 62 patients between 2011 and 2014 who presented to our Level I trauma center emergency room for acute traumatic injuries, and found to have subarachnoid hemorrhages on CT examination. The grade of subarachnoid hemorrhage was determined using previously utilized scoring systems, such as the Fisher, Modified Fisher, and Claassen grading systems. Electronic medical records were used to evaluate for medical decline, neurological decline, neurosurgical intervention, and overall hospital course. Admitting co-morbidities were noted, as were the presence of patient intoxication and use of anticoagulants. Patient outcomes were based on discharge summaries upon which the neurological status of the patient was assessed. Each patient was given a score based on the Glasgow outcome scale. The clinical and imaging profile of 62 patients with traumatic SAH were studied. Of the 62 patients, 0 % underwent neurosurgical intervention, 6.5 % had calvarial fractures, 25.8 % had additional intracranial hemorrhages, 27.4 % of the patients had significant co-morbidities, and 1.6 % of the patients expired. Patients with low-grade tSAH spent less time in the ICU, demonstrated neurological and medical stability during hospitalization. None of the patients with low-grade SAH experienced seizure during their admission. In our study, patients with low-grade tSAH demonstrated favorable clinical outcomes. This suggests that patients may not require as aggressive monitoring as is currently provided for those with tSAH.
authors.affiliation: Department of Radiology, The George Washington University, First Floor 900 23rd St NW, Washington, DC, 20037, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Albertine
authors.affiliation: Department of Radiology, The George Washington University, First Floor 900 23rd St NW, Washington, DC, 20037, USA. sborofsky@gwu.edu.
authors.forename: Samuel
authors.initials: S
authors.lastname: Borofsky
authors.affiliation: Department of Radiology, The George Washington University, First Floor 900 23rd St NW, Washington, DC, 20037, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Brown
authors.affiliation: Department of Radiology, The George Washington University, First Floor 900 23rd St NW, Washington, DC, 20037, USA.
authors.forename: Smita
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Radiology, The George Washington University, First Floor 900 23rd St NW, Washington, DC, 20037, USA.
authors.forename: Woojin
authors.initials: W
authors.lastname: Lee
authors.affiliation: Department of Radiology, The George Washington University, First Floor 900 23rd St NW, Washington, DC, 20037, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Caputy
authors.affiliation: Department of Radiology, The George Washington University, First Floor 900 23rd St NW, Washington, DC, 20037, USA.
authors.forename: M Reza
authors.initials: MR
authors.lastname: Taheri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D020206:Subarachnoid Hemorrhage, Traumatic / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D055815:Young Adult
keywords: CT; Subarachnoid hemorrhage; Trauma