Factors associated with the progression of traumatic intracranial hematoma during interventional radiology to establish hemostasis of extracranial hemorrhagic injury in severe multiple trauma patients

Hidenobu Ochiai; Tomohiro Abe; Hironobu Okuyama; Yasuhiro Nagamine; Sunao Morisada; Katsuhiro Kanemaru

doi:10.1002/ams2.580

Factors associated with the progression of traumatic intracranial hematoma during interventional radiology to establish hemostasis of extracranial hemorrhagic injury in severe multiple trauma patients

Acute Med Surg. 2020 Oct 27;7(1):e580. doi: 10.1002/ams2.580. eCollection 2020 Jan-Dec.

Authors

Hidenobu Ochiai¹, Tomohiro Abe¹, Hironobu Okuyama¹, Yasuhiro Nagamine¹, Sunao Morisada¹, Katsuhiro Kanemaru¹

Affiliation

¹ Department of Emergency and Critical Care Medicine Faculty of Medicine University of Miyazaki Miyazaki Japan.

Abstract

Aim: To identify factors affecting the progression of traumatic intracranial hemorrhagic injury (t-ICH) during interventional radiology (IVR) for the hemostasis of extracranial hemorrhagic injury.

Methods: This was a retrospective comparative study. Fifty-two patients with t-ICH who underwent hemostasis using IVR for extracranial trauma at our institute were included. Clinical and computed tomography scan data were collected to investigate factors associated with t-ICH progression.

Results: Fifty-two subjects (36 men/16 women) with a mean age of 70.9 ± 19.2 years were analyzed. The mean Injury Severity Score was 34.9 ± 11.2. In 29 patients (55.7%), t-ICH progressed during IVR. Hematoma progression frequently occurred in patients with acute subdural hematoma (56.2%) and traumatic intracerebral hematoma/hemorrhagic brain contusion (66.6%). Factors associated with t-ICH progression included age (P = 0.029), consciousness level at admission (P = 0.001), Revised Trauma Scale (P = 0.036), probability of survival (P = 0.043), platelet count (P = 0.005), fibrinogen level (P = 0.016), hemoglobin level (P = 0.003), D-dimer level (P = 0.046), and red blood cell transfusion volume (P = 0.023).

Conclusion: Aggressive correction of anemia, thrombocytopenia, and low fibrinogen levels in severe consciousness disturbance patients with acute subdural hematoma and traumatic intracerebral hematoma/hemorrhagic brain contusion could improve the prognosis after IVR for hemostasis of extracranial hemorrhagic injuries.

Keywords: Brain injury; consciousness; hemorrhagic shock; preventive measure.