Evolving traumatic brain lesions - Predictors and results of ninety-eight head-injured patients

Abstract

Progression in intracranial lesion(s) caused by traumatic brain injuries may be determined by a serial computerized tomography (CT) scan in the early period, but its significance is still controversial. In this study, the records of 98 head-injured patients in whom 2 consecutive CT scans were performed within 48 hours of injury were analyzed, and the predictors and clinical significance of progressive hemorrhagic injury (PHI) were determined. From June 1, 1998 through July 13, 2002, a cohort of 98 head-injured patients (65 male and 33 female, mean age of 34.8 years, and median Glasgow Come Scale [GCS] score of 11) was evaluated in this retrospective clinical study. The patients were divided into 2 groups: groups 1 and 2 included 51 and 47 patients without and with PHI, respectively. Progression in traumatic lesion(s) was determined by comparing the initial and repeated CT scans. Logistic regression analysis was used to identify physiologic parameters (P = 0.02), Injury Severity Score (P = 0.01), increased intracranial pressure (P = 0.005), and initial diagnosis (P = 0.01) as the best predictors of PHI. The 6-month postinjury outcome was favorable in group 1. PHI occurs mostly in intracerebral hematomas, which are associated with an increase in ICP. Age, increase in ICP, type of initial lesion(s), ISS, anemia, hypoxia, hyperglycemia, coagulopathy, and timing of the first CT scan relative to injury seem to be predictors of PHI.