Radiological Parameters to Predict Hemorrhagic Progression of Traumatic Contusional Brain Injury

• Main Authors: Lal Rehman, Ali Afzal, Hafiza Fatima Aziz, Sana Akbar, Asad Abbas, Raza Rizvi
• Format: Article
• Language: English
• Published: Thieme Medical and Scientific Publishers Pvt. Ltd. 2019-04-01
• Series: Journal of Neurosciences in Rural Practice
• Subjects: brain contusion; intracerebral hematoma; intraparenchymal hematoma; progressive hemorrhagic injury; traumatic brain injury
• Online Access: http://www.thieme-connect.de/DOI/DOI?10.4103/jnrp.jnrp_335_18
• ISSN: 0976-3147; 0976-3155

Introduction: Traumatic intracerebral contusion is a frequent factor culminating in death and disability, and its progression relates to unfavorable outcome. We evaluated the radiological factors associated with hemorrhagic progression of contusions (HPC). Materials and Methods: Two hundred and forty-six patients were enrolled in this prospective cohort over a period of 1 year. Contusion volume was quantified using the “ABC/2” technique, whereas progression was considered as >30% increase in the initial volume. Univariate and multivariate statistics were used to examine the correlation between the risk factors of interest and HPC. Results: HPC was seen in 110 (44.7%) patients. Binary logistic regression showed in the final adjusted model that multiplicity (relative risk [RR]: 2.24, 95% confidence limit [CL]: 1.00–5.48), bilateral lesions (RR: 2.99, 95% CL: 1.08–8.25), initial volume of contusion (RR: 4.96, 95% CL: 1.87–13.13), frontal location (RR: 1.42, 95% CL: 1.08–3.56), and presence of concomitant intracranial hematoma (extradural-RR: 3.90, 95% CL: 1.51–10.01, subdural-RR: 2.91, 95% CL: 1.26–6.69, and subarachnoid-RR: 2.27, 95% CL: 1.01–5.80) were significantly associated with HPC. The overall mortality was 18.7% and was almost equal among patients with and without HPC. Mortality was significantly associated with Glasgow Coma Scale on admission (adjusted RR: 12.386, 95% CL: 4.789–32.035) and presence of comorbid conditions (adjusted RR: 0.313, 95% CL: 0.114–0.860). Conclusion: Initial computed tomography scan is a good predictor of high-risk group for HPC.