Emily Winifred Rady, Bhairav Shah, Katrina Wierzbicki, Nathaniel Kenworthy, Michael Lieber, Michal Radomksi
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引用次数: 0
Abstract
Background: Computed tomography angiography of the head (CTAH) is not routinely obtained during the initial evaluation of patients with traumatic intracranial hemorrhage (ICH); however, it is useful for diagnosing vascular pathologies that may have led to the bleed. The aims of this study were to identify traumatic ICH patient characteristics on presentation that are associated with positive CTAH findings to elucidate which ones should prompt a CTAH and compare outcomes of patients with positive and negative CTAH findings.
Methods: This is a retrospective cohort study of 522 patients who had blunt traumatic ICH and subsequently received CTAH between January 1, 2017, and January 1, 2022. Patients were then sorted into two cohorts: positive and negative CTAH findings. The CTAH findings were our primary outcomes and included a spectrum of traumatic vascular injuries as well as nontraumatic vascular pathologies. Secondary outcomes included mortality, intensive care unit admission, intensive care unit length of stay, and neurological intervention rates.
Results: A total of 108 patients (20.7%) had positive CTAH findings. Patients with positive CTAH findings were more likely to be older, have lower heart rate, have more neurological deficits at admission, have fewer signs of external injury, and have increased need for cerebral angiogram and neuro-embolization. Patients with no pathologic CTAH findings were 3.9 times more likely to be alive at discharge. Initial heart rate and presence of neurological deficits on arrival were found to be independent predictors of positive CTAH findings.
Conclusion: Empiric CTAH is not necessary in all traumatic ICH patients. However, given the increased rates of neurologic procedures and mortality in patients with positive findings on CTAH, we recommend obtaining CTAH in blunt traumatic ICH patients who present with neurological deficits. The presence of external injuries alone should not influence the clinician's decision to obtain a CTAH.
Level of evidence: Prognostic and Epidemiological; Level III.
期刊介绍：
The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.
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