Traumatic Subarachnoid Hemorrhage Lesion Progression on Computed Tomography and Neurological Outcomes

Authors

  • Anukoon Kaewborisutsakul Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
  • Nakornchai Phuenpathom Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
  • Hutcha Sriplung Epidemiology unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

Keywords:

Traumatic subarachnoid hemorrhage, Lesion progression, Outcome

Abstract

Objective: The study aimed to investigate the neurological outcomes among traumatic brain injury patients with traumatic subarachnoid hemorrhage (tSAH) and the prognostic factors of intracranial lesion progression onadmission and subsequent-CT scans.

Materials and Methods: The study included moderate to severe traumatic brain injury patients who, had tSAH on admission and a CT scan between: January 2009 to December 2011. All patients, included in the study, had a subsequent CT scan within 48 hours after their initial scan. The outcomes were evaluated with Extended Glasgow Outcome Scale (GOSE) at 6 months after injury.

Results: 468 patients with moderate to severe traumatic brain injuries were reviewed. 147 patients (31.4%) had tSAH on admission along with a CT scan. Among this group, 38 patients (27.3%) had CT lesion progression. The 6-month mortality rate was 16.5%. Multivariate analysis, factors independently related to unfavorable outcome were age (adjusted OR 1.05, 95% CI 1.02-1.07), the Glasgow Coma Scale score (GCS) (adjusted OR 3.47, 95% CI 1.42-9.99) and lesion progression (adjusted OR 9.15, 95% CI 3.78-27.08)

Conclusion: The outcome of patients with tSAH at admission is related to age, admission GCS and significant CT progression.

References

1. Ministry of Public Health. Bureau of Health Policy and Strategy. Public health statistic 2010. Bangkok: The Ministry; 2010.

2. Ministry of Public Health. National Injury Surveillance. Annual epidermiological surveillance report 2010. Bangkok: The Ministry; 2010.

3. Wong GK, Yeung JH, Graham CA, Zhu XL, Rainer TH, Poon WS. Neurological outcome in patients with traumatic brain injury and its relationship with computed tomography patterns of traumatic subarachnoid hemorrhage. J Neurosurg 2011;114:1510-5.

4. Maas AI, Marmarou A, Murray GD, Teasdale SG, Steyerberg EW. Prognosis and clinical trial design in traumatic brain injury: The IMPACT study. J Neurotrauma 2007;24:232-8.

5. Perel P, Arango M, Clayton T, Edwards P, Komolafe E, Popcock S, et al. Predicting outcome after traumatic brain injury: Practical prognostic models based on large cohort of international patients. BMJ 2008;336:425-9.

6. Chieregato A, Fainardi E, Morselli-Labate AM, Antonelli V, Compagnone C, Targa L, et al. Factors associated with neurological outcome and lesion progression in traumatic subarachnoid hemorrhage patients. Neurosurgery 2005; 56:671-80.

7. Greene KA, Marciano FF, Johnson BA, Jacobowitz R, Spetzler RF, Harrington TR. Impact of traumatic subarachnoid hemorrhage on outcome in nonpenetrating head injury. Part I: A proposed computerized tomography grading scale. J Neurosurg1995;83:445-52.

8. Ishibashi A, Yokokura Y. Clinical analysis of traumatic subarachnoid hemorrhage. Kurume Med J 1991;38:167-71.

9. Tu CJ, Liu JS, Song DG, Zhen G, Luo HM, Liu WG, et al. Maximum thickness of subarachnoid blood is associated with mortality in patients with traumatic subarachnoid haemorrhage. J Int Med Res 2011;39:1757-65.

10. Husain N, Husain MA, Ahmad T. Outcome of traumatic subarachnoid hemorrhage. APMC 2010;4:166-71.

11. Servadei F, Murray GD, Teasdale GM, Dearden M, Lannotti F, Mass AJ, et al. Traumatic subarachnoid hemorrhage: Demographic and clinical study of 750 patients from the European brain injury consortium survey of head injuries. Neurosurgery 2002;50:261-7.

12. Martin NA, Doberstein C, Zane C, Caron MJ, Thomas K, Becker DP. Posttraumatic cerebral arterial spasm: Transcranial Doppler ultrasound, cerebral blood flow, and angiographic findings. J Neurosurg 1992;77:575-83.

13. Marshall LF, Klauber MR, van Berkum Clark M. A new classification of head injury based on computerized tomography. J Neurosurg 1991;75[Suppl]:S14-20.

14. Shukla D, Devi Bi Fauagrawal A, Agrawal A. Outcome measures for traumatic brain injury. Clin Neurol Neurosurg 2011; 113:435-41.

15. Freytag E. Autopsy findings in head injuries from blunt forces: Statistical evaluation of 1367 cases. Arch Pathol 1963; 75:402-13.

16. Kakarieka A, Braakman R, Schakel EH. Clinical significance of the finding of subarachnoid blood on CT scan after head injury. Acta Neurochir(Wien) 1994; 129:1-5.

17. Lee JJ, Segar DJ, Asaad WF. Comprehensive assessment of isolated traumatic subarachnoid hemorrhage. J Neurotrauma 2014;31:595-609.

18. Phelan HA, Richter AA, Scott WW, Pruitt JH, Madden CJ, Rickert KL, et al. Does isolated traumatic subarachnoid hemorrhage merit a lower intensity level of observation than other traumatic brain injury?. J Neurotrauma 2014;31:1733-6.

19. Harders A, Kakarieka A, Braakman R. Traumatic subarachnoid haemorrhage and its treatment with nimodipine: The German tSAH Study Group. J Neurosurg1996; 85:82-9.

20. Servadei F, Nasi MT, Giuliani G,Cremonini AM, Cenni P, Zappi D, et al. CT prognostic factors in acute subdural hematomas: The value of the “worst” CT scan. Br J Neurosurg2000; 14:110-6.

21. Miki T, Ikeda Y, Utsugi O, Ito H. Evaluation of traumatic subarachnoid haemorrhage on computed tomography. J Clin Neurosci 1998;5:49-57.

22. Morris GF, Marshall LF. A new practical classification of traumatic subarachnoid hemorrhage. Clin Neurol Neurosurg1997;99(Suppl 1):S16.

23. Stein SC, Spettel C, Young G, Ross SE. Delayed and progressive brain injury in closed-head trauma: radiological demonstration. Neurosurgery 1993;32:25-30.

24. Mattioli C, Beretta L, Gerevini S, Veglia F, Ceterio G, Cormio M, et al. Traumatic subarachnoid hemorrhage on the computerized tomography scan obtained at admission: a multicenter assessment of the accuracy of diagnosis and the_potential impact on patient outcome. J Neurosurg 2003; 98:37-42.

25. Greene KA, Jacobowitz R, Marciano FF, Johnson BA, Spetzler RF, Harrington TR. Impact of traumatic subarachnoid hemorrhage on outcome in nonpenetrating head injury. Part II: Relationship to clinical course and outcome variables during acute hospitalization. J Trauma 1996;41:964-71.
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Published

2018-12-31

How to Cite

1.
Kaewborisutsakul A, Phuenpathom N, Sriplung H. Traumatic Subarachnoid Hemorrhage Lesion Progression on Computed Tomography and Neurological Outcomes. Thai J Surg [Internet]. 2018 Dec. 31 [cited 2024 Apr. 26];39(4):115-21. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/227605

Issue

Vol. 39 No. 4 (2018): October - December

Section

Original Articles

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Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.