Predictors of Intracranial Hemorrhage on Initial Head Computed Tomography After Mild Traumatic Brain Injury.

BACKGROUND/AIM: Traumatic intracranial hemorrhage after mild traumatic brain injury (mTBI) remains a major clinical challenge, particularly in aging societies. This study characterized the incidence, clinical relevance, and associated clinical factors of computed tomography (CT)-positive traumatic intracranial lesions in adults with mTBI.

PATIENTS AND

METHODS

Relevant data were retrospectively collected from adults with mTBI who underwent head CT at our Emergency Department between April 2023 and April 2024. Clinical characteristics, medication exposure, CT findings, and the need for neurosurgical intervention were analyzed. CT images were interpreted in routine practice by Board-certified radiologists, and CT-positive cases were classified according to the Marshall CT criteria.

RESULTS

Of 471 patients (mean age: 70 years), 66 (14.0%) had CT-confirmed traumatic intracranial hemorrhage. Male sex and antiplatelet use were more frequent in the CT-positive group than in the CT-negative group (59.1% vs. 39.8%, p=0.003; and 9.1% vs. 2.7%, p=0.021, respectively). Falling was the predominant mechanism of injury (86.6%). Traumatic subarachnoid hemorrhage (50.0%) and intracerebral hemorrhage or contusion (42.4%) were the most common CT findings. Most CT-positive cases were Marshall grade II (93.9%), and eight patients (12.1% of CT-positive cases; 1.7% of the total cohort) required neurosurgical intervention. In a prespecified descriptive subgroup analysis of patients with numerically documented triage Glasgow Coma Scale scores of 13-15, clinically relevant CT-positive lesions and neurosurgical interventions were still observed in the GCS 15 subgroup.

CONCLUSION

In this CT-selected older cohort with mTBI, CT-positive traumatic intracranial lesions were not rare. Although most lesions were radiologically mild, a clinically important minority required neurosurgical intervention. These findings support emphasizing radiological severity and downstream management, not CT positivity alone, when evaluating older adults with mTBI.