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

Rau, Cheng-Shyuan; Wu, Shao-Chun; Hsu, Shiun-Yuan; Liu, Hang-Tsung; Huang, Chun-Ying; Hsieh, Ting-Min; Chou, Sheng-En; Su, Wei-Ti; Liu, Yueh‐Wei; Hsieh, Ching-Hua

doi:10.3390/ijerph16234787

Cited by 13 publications

(9 citation statements)

References 37 publications

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“…Increased posttraumatic diffuse cerebral edema mortality reflected diffuse brain injury and decreased cerebral perfusion, resulting from increased ICP. Traumatic SAH indicates increased head injury severity and is a well-established poor prognostic factor [26]. The significantly short hospital stay for cerebral edemas found here is likely related to poor survivability and early death among them.…”

Section: Discussionmentioning

confidence: 65%

Investigating the Association between Orthopedic Fractures and Head Injury due to Road Traffic Accidents

Al-Gahtany

2021

Applied Bionics and Biomechanics

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Background. Traumatic head injury (THI) due to road traffic accidents (RTAs) is a global health problem. Studies exploring the association between RTA-related THI and concurrent orthopedic fractures are lacking. We aim to provide a detailed analysis of this association and its impact on inhospital outcomes. Methods. Retrospective analysis of RTA-related THI associated with orthopedic fractures admitted to a large tertiary center, Southwest, Saudi Arabia, over ten years. Descriptive statistics for participant demographics and clinical outcomes were represented by percentages. The associations between head injury diagnosis or orthopedic fractures region and patient demographics are analyzed using the Chi-square test. Post hoc analysis for the significant Chi-square values was carried out by calculating the significant adjusted residuals. Adjust p value was obtained by using the Benjamini-Hochberg procedure to control for multiplicity testing. A p value less than 0.05 was considered statistically significant. Results. Concurrent orthopedic fractures are present in one-tenth of RTA-related THI. The cohort was dominated by young males, with 46.5% of the population between 18 and 29 years old. There was a significant association between the head injury diagnosis and the region of orthopedic fracture ( p = 0.028 ). The type of head injury had significant associations with mortality and duration of hospital stay ( p = 0.039 and p = 0.037 , respectively). The region of orthopedic fracture significantly ( p = 0.018 ) affected the duration of hospital stay, with fractures in the clavicle/shoulder region significantly ( p = 0.035 ) having a short course of hospital admission. Conclusion. Orthopedic fractures concomitant with RTA-related THI are common. The associations between the two injuries tend to happen in specific patterns. The inhospital stay duration and mortality significantly correlated with the site of the head or orthopedic injury. Knowledge of these patterns improves the care of THI victims, triaging, and resource allocations.

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Section: Discussionmentioning

confidence: 65%

Investigating the Association between Orthopedic Fractures and Head Injury due to Road Traffic Accidents

Al-Gahtany

2021

Applied Bionics and Biomechanics

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“…Previous literature has suggested that SAH is more predictive of TBI mortality when it occurs simultaneously with another tICH, such as SDH (17,18). We examined the mortality in subgroups of the SAH population, including SAH with concurrent SDH, SAH without SDH, and SAH without other tICH.…”

Section: Post-hoc Testsmentioning

confidence: 99%

Predictors of Mortality in Traumatic Intracranial Hemorrhage: A National Trauma Data Bank Study

Marthi

Asaad

2020

Front. Neurol.

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Background/Objective: Traumatic intracranial hemorrhage (tICH) accounts for significant trauma morbidity and mortality. Several studies have developed prognostic models for tICH outcomes, but previous models face limitations, including poor generalizability and limited accuracy. The objective was to develop a prognostic model and determine predictors of mortality using the largest trauma database in the U.S., applying rigorous analytical methodology with true hold-out-set model validation. Methods: We identified 248,536 patients in the National Trauma Data Bank (NTDB) from 2012 to 2016 with a diagnosis code associated with tICH. For each admission, we collected demographic information, systolic blood pressure, blood alcohol level (BAL), Glasgow Coma Score (GCS), Injury Severity Score (ISS), presence of epidural/subdural/subarachnoid/intraparenchymal hemorrhage, comorbidities, complications, trauma center level, and trauma center region. Our final study population was 212,666 patients following exclusion of records with missing data. The dependent variable was patient death. Linear support vector machine (SVM) classification was carried out with recursive feature selection. Model performance was assessed using holdout 10-fold cross-validation. Results: Cross-validation demonstrated a mean accuracy of 0.792 (95% CI 0.783–0.799). Accuracy, precision, recall, and AUC were 0.827, 0.309, 0.750, and 0.791, respectively. In the final model, high ISS, advanced age, subdural hemorrhage, and subarachnoid hemorrhage were associated with increased mortality, while high GCS verbal and motor subscores, current smoker, BAL beyond the legal limit, and level 1 trauma center were associated with decreased mortality. Conclusions: A linear SVM model was developed for tICH, with nine features selected as predictors of mortality. These findings are applicable to multiple hemorrhage subtypes and may benefit the triage of high risk patients upon admission. While many studies have attempted to create models to predict mortality in TBI, we sought to confirm those predictors using modern modeling approaches, machine learning, and true hold-out test sets, using the largest available TBI database in the U.S. We find that while the predictors we identify are consistent with prior reports, overall prediction accuracy is somewhat lower than prior reports when assessed more rigorously.

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“…A cross-sectional study of 1856 patients with TSAH found that patients with iTSAH had a 1.8% mortality rate, compared with patients with SAH + one diagnosis (7.9%), SAH + two diagnoses (12.4%), and SAH + three diagnoses (27.3%), where one, two, and three diagnoses indicated the existence of one, two, or three other types of intracranial hemorrhage (subdural hematoma, epidural hematoma, or ICH). 38 When controlling for sex, age, and pre-existing comorbidities, Group II, Group III, and Group IV patients had a 4.0, 8.9, and 21.1 times higher adjusted OR for death, respectively, than the patients with iTSAH.…”

Section: Review Findingsmentioning

confidence: 92%

Traumatic Subarachnoid Hemorrhage: A Scoping Review

Griswold

Fernández

Rubiano

2022

Journal of Neurotrauma

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Sixty-nine million people have a traumatic brain injury (TBI) each year, and TBI is the most common cause of subarachnoid hemorrhage (SAH). Traumatic SAH (TSAH) has been described as an adverse prognostic factor leading to progressive neurological deterioration and increased morbidity and mortality. A limited number of studies, however, evaluate recent trends in the diagnosis and management of SAH in the context of trauma. The objective of this scoping review was to understand the extent and type of evidence concerning the diagnostic criteria and management of TSAH. This scoping review was conducted following the Joanna Briggs Institute methodology for scoping reviews. The review included adults with SAH secondary to trauma, where isolated TSAH (iTSAH) refers to the presence of SAH in the absence of any other traumatic radiographic intracranial pathology, and TSAH refers to the presence of SAH with the possibility or presence of additional traumatic radiographic intracranial pathology. Data extracted from each study included study aim, country, methodology, population characteristics, outcome measures, a summary of findings, and future directives. Thirty studies met inclusion criteria. Studies were grouped into five categories by topic: TSAH associated with mild TBI (mTBI), n = 13), and severe TBI ( n = 3); clinical management and diagnosis ( n = 9); imaging ( n = 3); and aneurysmal TSAH ( n = 1). Of the 30 studies, two came from a low- and middle-income country (LMIC), excluding China, nearly a high-income country. Patients with TSAH associated with mTBI have a very low risk of clinical deterioration and surgical intervention and should be treated conservatively when considering intensive care unit admission. The Helsinki and Stockholm computed tomography scoring systems, in addition to the American Injury Scale, creatinine level, age decision tree, may be valuable tools to use when predicting outcome and death.

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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

Cited by 13 publications

References 37 publications

Investigating the Association between Orthopedic Fractures and Head Injury due to Road Traffic Accidents

Investigating the Association between Orthopedic Fractures and Head Injury due to Road Traffic Accidents

Predictors of Mortality in Traumatic Intracranial Hemorrhage: A National Trauma Data Bank Study

Traumatic Subarachnoid Hemorrhage: A Scoping Review

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