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. 2019 Nov 29;16(23):4787.
doi: 10.3390/ijerph16234787.

Concurrent Types of Intracranial Hemorrhage Are Associated With a Higher Mortality Rate in Adult Patients With Traumatic Subarachnoid Hemorrhage: A Cross-Sectional Retrospective Study

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Concurrent Types of Intracranial Hemorrhage Are Associated With a Higher Mortality Rate in Adult Patients With Traumatic Subarachnoid Hemorrhage: A Cross-Sectional Retrospective Study

Cheng-Shyuan Rau et al. Int J Environ Res Public Health. .
Free PMC article

Abstract

Traumatic subarachnoid hemorrhage (SAH) is the second most frequent intracranial hemorrhage and a common radiologic finding in computed tomography. This study aimed to estimate the risk of mortality in adult trauma patients with traumatic SAH concurrent with other types of intracranial hemorrhage, such as subdural hematoma (SDH), epidural hematoma (EDH), and intracerebral hemorrhage (ICH), compared to the risk in patients with isolated traumatic SAH. We searched our hospital's trauma database from 1 January, 2009 to 31 December, 2018 to identify hospitalized adult patients ≥20 years old who presented with a trauma abbreviated injury scale (AIS) of ≥3 in the head region. Polytrauma patients with an AIS of ≥3 in any other region of the body were excluded. A total of 1856 patients who had SAH were allocated into four exclusive groups: (Group I) isolated traumatic SAH, n = 788; (Group II) SAH and one diagnosis, n = 509; (Group III) SAH and two diagnoses, n = 493; and (Group IV) SAH and three diagnoses, n = 66. One, two, and three diagnoses indicated occurrences of one, two, or three other types of intracranial hemorrhage (SDH, EDH, or ICH). The adjusted odds ratio with a 95% confidence interval (CI) of the level of mortality was calculated with logistic regression, controlling for sex, age, and pre-existing comorbidities. Patients with isolated traumatic SAH had a lower rate of mortality (1.8%) compared to the other three groups (Group II: 7.9%, Group III: 12.4%, and Group IV: 27.3%, all p < 0.001). When controlling for sex, age, and pre-existing comorbidities, we found that Group II, Group III, and Group IV patients had a 4.0 (95% CI 2.4-6.5), 8.9 (95% CI 4.8-16.5), and 21.1 (95% CI 9.4-47.7) times higher adjusted odds ratio for mortality, respectively, than the patients with isolated traumatic SAH. In this study, we demonstrated that compared to patients with isolated traumatic SAH, traumatic SAH patients with concurrent types of intracranial hemorrhage have a higher adjusted odds ratio for mortality.

Keywords: epidural hematoma (EDH); intracerebral hemorrhage (ICH); mortality; subarachnoid hemorrhage (SAH); subdural hematoma (SDH); traumatic brain injury.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Flow chart illustrating the inclusion of adult patients with acute traumatic subarachnoid hemorrhage and the allocation of these patients into four groups. AIS—abbreviated injury scale, Dx—diagnosis, and SAH—subarachnoid hemorrhage. One, two, and three diagnoses indicated occurrences of one, two, or three other types of intracranial hemorrhage (subdural hematoma, epidural hematoma, or intracerebral hemorrhage).
Figure 2
Figure 2
The allocation of adult patients with acute traumatic subarachnoid hemorrhage into four groups: SAH, epidural hematoma (EDH), subdural hematoma (SDH), and intracerebral hemorrhage (ICH).

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