Subarachnoid versus nonsubarachnoid traumatic brain injuries: The impact of decision-making on patient safety

Diaz, Brandon; Elkbuli, Adel; Wobig, Rachel; McKenney, Kelly; Jaguan, Daniella; Boneva, Dessy; Hai, Shaikh; McKenney, Mark

doi:10.4103/jets.jets_123_18

Cited by 7 publications

(5 citation statements)

References 9 publications

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“…A retrospective cohort study comparing 225 iTSAH patients and 826 non-SAH-ICH patients found that 0.89% (n=2) tSAH patients and 12.1% (n=100) of non-SAH-ICH patients required neurosurgical intervention. 14 Mortality rates were 1.78% (n=4/225) in the SAH patients and 2.66% (n=22/826) in the non-SAH-ICH patients.…”

Section: Resultsmentioning

confidence: 89%

Traumatic subarachnoid hemorrhage: a scoping review

Griswold

Fernández

Rubiano

2021

Preprint

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Sixty-nine million people suffer from 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. However, a limited number of studies evaluate recent trends in the diagnostic 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 traumatic subarachnoid hemorrhage. This scoping review was conducted following the JBI methodology for scoping reviews. The review included adults who suffered SAH secondary to trauma. 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 (n=13), and severe TBI (n=3); clinical management and diagnosis (n=9); imaging (n=3); and 5) 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 managed conservatively when considering ICU admission. The Helsinki and Stockholm CT scoring systems, in addition to the AIS, Cr, age decision tree, may be valuable tools to use when predicting outcome and mortality.

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Section: Resultsmentioning

confidence: 89%

Traumatic subarachnoid hemorrhage: a scoping review

Griswold

Fernández

Rubiano

2021

Preprint

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“…Compared to Group I patients, there were significantly more patients in Group III who had HTN and DM. The group of patients with isolated traumatic SAH had a significantly higher GCS score (median [Q1–Q3]: 15 [14,15]) than the other three groups (Group II: 14 [10,11,12,13,14,15], Group III: 13 [7,8,9,10,11,12,13,14,15], and Group IV: 8 [4,5,6,7,8,9,10,11,12,13,14]), as well as a smaller percentage of patients with a GCS score of ≤ 8 and a greater percentage of patients with a GCS score of ≥13. In addition, the group of patients with isolated traumatic SAH had a significantly lower ISS (median [Q1–Q3]: 11 [9,10,11,12,13,14]) than the other three groups (Group II: 16 [16,17,18,19,20], Group III: 17 [16,17,18,19,20,21,22,23,24], and Group IV: 21 [16,17,18,19,20,21,22,23,24,25]) and presented with a greater percentage of patients with a ISS of <16 and a smaller percentage of patients with a ISS between 16–24 and ≥25.…”

Section: Resultsmentioning

confidence: 99%

“…The actual death rate and the requirement for neurosurgical intervention in SAH cases is significantly lower than in cases of non-SAH intracranial hemorrhages [8]. In addition, the outcome is good for patients with isolated traumatic SAH, which is defined as the exclusive presence of SAH without any other traumatic, radiographic intracranial pathology in the trauma patient.…”

Section: Introductionmentioning

confidence: 99%

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

Hsu

et al. 2019

IJERPH

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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.

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“…Subarachnoid haemorrhage (SAH) refers to the accumulation of blood within the subarachnoid space. The aetiology of SAH can be broadly classified into 2 categories: traumatic SAH and non-traumatic or spontaneous SAH [ 1 ]. Traumatic SAH, which frequently occurs after head trauma, is typically a benign condition that exhibits a favourable prognosis, rarely necessitating surgical intervention [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…The aetiology of SAH can be broadly classified into 2 categories: traumatic SAH and non-traumatic or spontaneous SAH [ 1 ]. Traumatic SAH, which frequently occurs after head trauma, is typically a benign condition that exhibits a favourable prognosis, rarely necessitating surgical intervention [ 1 ]. Unlike spontaneous SAH, which has the risk of a life-threatening condition.…”

Section: Introductionmentioning

confidence: 99%

The diagnostic yield of repeat computed tomography angiography in cases of spontaneous subarachnoid haemorrhage after negative initial digital subtraction angiography

Amantakul,

Vuthiwong,

Khiawsa

2024

Pol J Radiol

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PurposeIt is currently unclear how useful repeat computed tomography angiography (CTA) is in spontaneous subarachnoid haemorrhage (SAH) patients after negative initial digital subtraction angiography (DSA). The purpose of this study is to assess the yield of repeat CTA for the detection of causative vascular lesions in patients with SAH in whom there has been a negative initial DSA.Material and methodsThis observational retrospective study was carried out from January 2013 to July 2022 at a single institution. Analysis of the SAH pattern on unenhanced CT showed that patients were divided into perimesencephalic SAH and diffuse SAH groups. A repeat CTA was performed on all spontaneous SAH patients who had a negative initial CTA and DSA within a 2-week period. An interventional neuroradiologist and a diagnostic radiologist examined all images to search for causative vascular abnormalities.ResultsForty-seven patients were included in our study, with a median age of 55 years and a range of 28-81 years. Thirty-seven had diffuse SAH (66%), and 16 had perimesencephalic SAH (34%). The repeat CTA revealed 2 causative vascular lesions (a right PICA aneurysm and a mycotic aneurysm) in 2 separate patients (yield of 4.3%), both of whom had diffuse SAH (yield of 6.5%). In retrospect, none of these vascular lesions were evident in the initial CTA and DSA. No evidence of re-bleeding was observed in the follow-up period.ConclusionsIt is beneficial to repeat CTA when evaluating patients with diffuse SAH who initially present with negative initial DSA. For occult aneurysms, the diagnostic yield of the follow-up CTA is 6.5%.

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Subarachnoid versus nonsubarachnoid traumatic brain injuries: The impact of decision-making on patient safety

Cited by 7 publications

References 9 publications

Traumatic subarachnoid hemorrhage: a scoping review

Traumatic subarachnoid hemorrhage: a scoping review

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

The diagnostic yield of repeat computed tomography angiography in cases of spontaneous subarachnoid haemorrhage after negative initial digital subtraction angiography

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