Progression of intracranial hemorrhages in neurotrauma patients: A clinical and radiological comparison of isolated versus multiple areas of hemorrhage and associated transfusion treatment strategies

Purpose

The similar presentation of patients with multiple simultaneous (mICHs) or isolated (iICH) intracranial hemorrhages prompted investigation of clinical and radiological ICH progression during hospitalization in these cohorts. We also examined the role of aggressive transfusion and acute interventions on patient morbidity and mortality.

Methods

Adult (>18 years) neurotrauma patients treated at our Level 1 trauma center between January 1, 2002, and December 31, 2022, with an iICH or mICH were included based on meeting 5 criteria: isolated neurotrauma; ICH injury beyond subarachnoid hemorrhage; repeat head CT available; no anticoagulant usage; and survivable injuries. Data collected retrospectively included demographics, potential risk factors for ICH, injury type, management details, transfusion characteristics, and outcomes. The primary outcome was the clinical and radiological progression of ICH during hospitalization, and the secondary outcome was the role of aggressive transfusion and acute interventions on patient morbidity and mortality.

Results

Among the 596 patients, 242 had iICH and 354 had mICH. Other than age (p = .01) and Glasgow Coma Scale score (p < .001), most presentation characteristics, including comorbidities, were similar in the two groups. Although patients with iICH were less likely to have subarachnoid hemorrhage (p < .001), epidural hematoma (p = .03), intraparenchymal hematoma (p < .001), and hemorrhagic contusions (p < .001), subdural hematomas were equally likely to occur in both groups (p = .52). There were no significant differences in neurosurgical treatment by ICH type. There were no significant differences in progression on imaging or transfusions received between the two groups.

Conclusion

Although our data are limited as a single-center retrospective analysis, these results highlight the similarities between patients with iICH and mICH and indicate that treatment may be independent of the number of bleeds.