Classification, risk factors, and outcomes of patients with progressive hemorrhagic injury after traumatic brain injury
Abstract Background According to the pathoanatomic classification system, progressive hemorrhagic injury (PHI) can be categorized into progressive intraparenchymal contusion or hematoma (pIPCH), epidural hematoma (pEDH), subdural hematoma (pSDH), and traumatic subarachnoid hemorrhage (ptSAH). The cl...
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | BMC Neurology |
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| Online Access: | https://doi.org/10.1186/s12883-023-03112-x |
| _version_ | 1797864332225150976 |
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| author | Ren Wang Dian-Xu Yang Jun Ding Yan Guo Wan-Hai Ding Heng-Li Tian Fang Yuan |
| author_facet | Ren Wang Dian-Xu Yang Jun Ding Yan Guo Wan-Hai Ding Heng-Li Tian Fang Yuan |
| author_sort | Ren Wang |
| collection | DOAJ |
| description | Abstract Background According to the pathoanatomic classification system, progressive hemorrhagic injury (PHI) can be categorized into progressive intraparenchymal contusion or hematoma (pIPCH), epidural hematoma (pEDH), subdural hematoma (pSDH), and traumatic subarachnoid hemorrhage (ptSAH). The clinical features of each type differ greatly. The objective of this study was to determine the predictors, clinical management, and outcomes of PHI according to this classification. Methods Multivariate logistic regression analysis was used to identify independent risk factors for PHI and each subgroup. Patients with IPCH or EDH were selected for subgroup propensity score matching (PSM) to exclude confounding factors before evaluating the association of hematoma progression with the outcomes by classification. Results In the present cohort of 419 patients, 123 (29.4%) demonstrated PHI by serial CT scan. Of them, progressive ICPH (58.5%) was the most common type, followed by pEDH (28.5%), pSDH (9.8%), and ptSAH (3.2%). Old age (≥ 60 years), lower motor Glasgow Coma Scale score, larger primary lesion volume, and higher level of D-dimer were independent risk factors related to PHI. These factors were also independent predictors for pIPCH, but not for pEDH. The time to first CT scan and presence of skull linear fracture were robust risk factors for pEDH. After PSM, the 6-month mortality and unfavorable survival rates were significantly higher in the pIPCH group than the non-pIPCH group (24.2% vs. 1.8% and 12.1% vs. 7.3%, respectively, p < 0.001), but not significantly different between the pEDH group and the non-pEDH group. Conclusions Understanding the specific patterns of PHI according to its classification can help early recognition and suggest targeted prevention or treatment strategies to improve patients’ neurological outcomes. |
| first_indexed | 2024-04-09T22:51:08Z |
| format | Article |
| id | doaj.art-142703abe1564447bcf5a58641717782 |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-04-09T22:51:08Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-142703abe1564447bcf5a586417177822023-03-22T11:38:32ZengBMCBMC Neurology1471-23772023-02-012311910.1186/s12883-023-03112-xClassification, risk factors, and outcomes of patients with progressive hemorrhagic injury after traumatic brain injuryRen Wang0Dian-Xu Yang1Jun Ding2Yan Guo3Wan-Hai Ding4Heng-Li Tian5Fang Yuan6Department of Neurosurgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong UniversityDepartment of Neurosurgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong UniversityDepartment of Neurosurgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong UniversityDepartment of Neurosurgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong UniversityDepartment of Neurosurgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong UniversityDepartment of Neurosurgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong UniversityDepartment of Neurosurgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong UniversityAbstract Background According to the pathoanatomic classification system, progressive hemorrhagic injury (PHI) can be categorized into progressive intraparenchymal contusion or hematoma (pIPCH), epidural hematoma (pEDH), subdural hematoma (pSDH), and traumatic subarachnoid hemorrhage (ptSAH). The clinical features of each type differ greatly. The objective of this study was to determine the predictors, clinical management, and outcomes of PHI according to this classification. Methods Multivariate logistic regression analysis was used to identify independent risk factors for PHI and each subgroup. Patients with IPCH or EDH were selected for subgroup propensity score matching (PSM) to exclude confounding factors before evaluating the association of hematoma progression with the outcomes by classification. Results In the present cohort of 419 patients, 123 (29.4%) demonstrated PHI by serial CT scan. Of them, progressive ICPH (58.5%) was the most common type, followed by pEDH (28.5%), pSDH (9.8%), and ptSAH (3.2%). Old age (≥ 60 years), lower motor Glasgow Coma Scale score, larger primary lesion volume, and higher level of D-dimer were independent risk factors related to PHI. These factors were also independent predictors for pIPCH, but not for pEDH. The time to first CT scan and presence of skull linear fracture were robust risk factors for pEDH. After PSM, the 6-month mortality and unfavorable survival rates were significantly higher in the pIPCH group than the non-pIPCH group (24.2% vs. 1.8% and 12.1% vs. 7.3%, respectively, p < 0.001), but not significantly different between the pEDH group and the non-pEDH group. Conclusions Understanding the specific patterns of PHI according to its classification can help early recognition and suggest targeted prevention or treatment strategies to improve patients’ neurological outcomes.https://doi.org/10.1186/s12883-023-03112-xTraumatic brain injuryProgressive hemorrhagic injuryClassificationpropensity score matching, outcomes |
| spellingShingle | Ren Wang Dian-Xu Yang Jun Ding Yan Guo Wan-Hai Ding Heng-Li Tian Fang Yuan Classification, risk factors, and outcomes of patients with progressive hemorrhagic injury after traumatic brain injury BMC Neurology Traumatic brain injury Progressive hemorrhagic injury Classification propensity score matching, outcomes |
| title | Classification, risk factors, and outcomes of patients with progressive hemorrhagic injury after traumatic brain injury |
| title_full | Classification, risk factors, and outcomes of patients with progressive hemorrhagic injury after traumatic brain injury |
| title_fullStr | Classification, risk factors, and outcomes of patients with progressive hemorrhagic injury after traumatic brain injury |
| title_full_unstemmed | Classification, risk factors, and outcomes of patients with progressive hemorrhagic injury after traumatic brain injury |
| title_short | Classification, risk factors, and outcomes of patients with progressive hemorrhagic injury after traumatic brain injury |
| title_sort | classification risk factors and outcomes of patients with progressive hemorrhagic injury after traumatic brain injury |
| topic | Traumatic brain injury Progressive hemorrhagic injury Classification propensity score matching, outcomes |
| url | https://doi.org/10.1186/s12883-023-03112-x |
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