title: Subdural hematoma as a major determinant of short-term outcomes in traumatic brain injury.
abstract: OBJECTIVE Early radiographic findings in patients with traumatic brain injury (TBI) have been studied in hopes of better predicting injury severity and outcome. However, prior attempts have generally not considered the various types of intracranial hemorrhage in isolation and have typically not excluded patients with potentially confounding extracranial injuries. Therefore, the authors examined the associations of various radiographic findings with short-term outcome to assess the potential utility of these findings in future prognostic models. METHODS The authors retrospectively identified 1716 patients who had experienced TBI without major extracranial injuries, and categorized them into the following TBI subtypes: subdural hematoma (SDH), traumatic subarachnoid hemorrhage, intraparenchymal hemorrhage (which included intraventricular hemorrhage), and epidural hematoma. They specifically considered isolated forms of hemorrhage, in which only 1 subtype was present. RESULTS In general, the presence of an isolated SDH was more likely to result in worse outcomes than the presence of other isolated forms of traumatic intracranial hemorrhage. Discharge to home was less likely and perihospital mortality rates were generally higher in patients with SDH. These findings were not simply related to age and were not fully captured by the admission Glasgow Coma Scale (GCS) score. The presence of SDH had a much higher sensitivity for poor outcome than the presence of other TBI subtypes, and was more sensitive for these poor outcomes than having a low GCS score (3-8). CONCLUSIONS In these ways, SDH was the most important finding associated with poor outcome, and the authors show that consideration of SDH, specifically, can augment age and GCS score in classification and prognostic models for TBI.
authors.affiliation: 1Warren Alpert Medical School of Brown University.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: 1Warren Alpert Medical School of Brown University.
authors.forename: David J
authors.initials: DJ
authors.lastname: Segar
authors.affiliation: 1Warren Alpert Medical School of Brown University.|2Department of Neurosurgery, Rhode Island Hospital.
authors.forename: John F
authors.initials: JF
authors.lastname: Morrison
authors.affiliation: 1Warren Alpert Medical School of Brown University.
authors.forename: William M
authors.initials: WM
authors.lastname: Mangham
authors.affiliation: 3Brown Institute for Brain Science.|4Department of Neuroscience, Brown University; and.
authors.forename: Shane
authors.initials: S
authors.lastname: Lee
authors.affiliation: 1Warren Alpert Medical School of Brown University.|2Department of Neurosurgery, Rhode Island Hospital.|3Brown Institute for Brain Science.|4Department of Neuroscience, Brown University; and.|5Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Wael F
authors.initials: WF
authors.lastname: Asaad
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D020206:Subarachnoid Hemorrhage, Traumatic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D055815:Young Adult
keywords: AIS = Abbreviated Injury Scale; EDH = epidural hematoma; GCS = Glasgow Coma Scale; ICD-9 = International Classification of Diseases, Ninth Revision; IPH = intraparenchymal hemorrhage; IVH = intraventricular hemorrhage; SDH = subdural hematoma; SNF = skilled nursing facility; TBI = traumatic brain injury; TBI−, TBI+ = TBI without major extracranial injury, TBI with major extracranial injury; head injury; subdural hematoma; tSAH = traumatic subarachnoid hemorrhage; trauma; traumatic brain injury