Progression of mild traumatic brain injury with intracranial hemorrhage: a retrospective study of associated factors in patients managed conservatively in the emergency department.

BACKGROUND AND

OBJECTIVE

Patients with mild traumatic brain injury (mTBI) presenting with intracranial hemorrhage (ICH) represent a heterogeneous group, with some experiencing clinical or radiologic deterioration despite initial stability. This study aimed to identify factors associated with clinically significant progression, defined as clinical or radiological worsening resulting in hospital admission or neurosurgical intervention, among patients with mTBI and ICH evaluated in the Emergency Department (ED) of Ramathibodi Hospital, Thailand.

METHODS

A retrospective review was conducted of adult patients with mTBI (Glasgow Coma Scale [GCS] 13-15) and radiologically confirmed ICH who presented to the ED between 2019 and 2023. Data were retrieved from the hospital electronic medical record system. Patients managed conservatively with at least one repeated computed tomography (CT) scan were included in the study. Clinical and radiologic variables were analyzed using multivariable logistic regression to identify independent factors associated with progression.

RESULTS

Among 114 eligible patients, 26 (22.8%) demonstrated progression requiring hospital admission or neurosurgical intervention. Independent predictors of progression were midline shift (OR 11.58, 95% CI 2.93-45.78, p < 0.001), systolic blood pressure ≥160 mmHg (OR 5.49, 95% CI 1.69-17.77, p = 0.005), multiple ICH (OR 3.69, 95% CI 1.13-11.98, p = 0.030), and initial GCS 13-14 (OR 4.86, 95% CI 1.18-20.08, p = 0.029).

CONCLUSION

These findings may help guide decisions regarding closer observation and repeat CT brain imaging in patients at higher risk of progression.