Factors predicting early deterioration in mild brain trauma: A prospective study. (December 2013) - Seddighi, Amir Saied
Abstract Primary objective: To evaluate risk factors for clinical deterioration in mild traumatic brain injury. Research design: Prospective cross-sectional. Methods and procedures: This study evaluated 203 patients with mild traumatic brain injury. A brain computed tomography scan was performed in all patients and they were observed for 6–48 hours. Main outcomes and results: Among these patients, 2.5% had cerebral contusions and the most common sites for contusions were frontal lobes; 94% of patients had no hematoma in the initial scan, while 3% had subgaleal haematoma, 1.5% had subdural haematoma, 1% showed subarachnoid haemorrhage, 0.5% intracerebral haemorrhage and 0.5% epidural haemorrhage. GCS was 15 in 96.6% and 13–14 in 3.4%. GCS deteriorated in three (1.5%). Presence of coagulopathy, anticoagulant drug use, GCS of 13–14 and increased age predicted further deterioration. Among CT findings, those with midline shift, cerebral contusion and diffuse cerebral oedema deteriorated more. Among different haematoma types, only SDH predicted a worse outcome. Conclusions: Although deterioration rarely occurs in patients with mild brain injury, those with coagulopathy, anticoagulant drug use, GCS of 13–14, increased age, midline shift, cerebral contusions, diffuse cerebral oedema and SDH were more prone to deterioration.