Natural Course and Risk Factors for Progression of Mild Traumatic Brain Injury Associated Intra-Cranial Hemorrhage: A Cohort Study From a Trauma Centre

Abstract

Background: Intra-cranial bleeding takes place in about 15% of patients with mild traumatic brain injury (mTBI). The risk factors for progression and expansion of hematoma and their natural course is not well known. This study was designed to elucidate the natural course, risk factors, and time interval for progression or regression of the post-mTBI intra-cranial hemorrhages (ICH).

Materials and Methods: Eighty two patients with mTBI suffering intra-cranial hematoma on their initial brain CT scan were prospectively enrolled in a cohort study and data including accident characteristics, past medical history, and physical examination on their arrival were registered. They all underwent initial and repeat brain CT scans according to the protocol in our institute. Natural course of hematoma was demonstrated and data analysis of the patients’ characteristics and their CT scan findings was performed to elucidate risk factors associated with hematoma progression or the need for intervention.

Results: Age, sex, anti-coagulants, diabetes, associated trauma, type of the accident, transportation time, hemodynamic parameters, initial GCS, signs of skull base trauma, para-clinical measures, and primary size of hematoma were not associated with increased risk of hematoma progression (p>0.05). Sub-arachnoid and subdural hemorrhages resorbed after 6 days while epidural hematoma resorbed after 16 days from the accident.

Conclusion: In this study, in accordance with previous studies, hematoma progression was preceded by clinical decline in all cases. It may be safe to discharge patients with normal sensorium after 24 h who do not show evidence of hematoma progression on repeat brain CT scan. However, further studies to externally validate these findings are warranted.