The profile of blunt traumatic supratentorial cranial bleed types. (January 2019)

• Record Type: Journal Article
• Authors: Shpiner, Aaron C.; Bugaev, Nikolay; Riesenburger, Ron; Ng, Isaac; Breeze, Janis L.; Arabian, Sandra S.; Rabinovici, Reuven
• Is Part Of: Journal of clinical neuroscience. Volume 59(2019)
• Page Start: 79
• Page End: 83
• Publication Date: 2019-01
• Subjects: Traumatic brain injury -- Intracranial bleed -- Supratentorial bleed; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.10.149
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: There are clinically significant differences in distributions, clinical courses and outcomes of different subtypes of traumatic infratentorial bleeds. Subdural hemorrhage is the most common traumatic supratentorial bleed. The most common mechanism of injury was from falls. The majority of traumatic infratentorial bleeds present as mild severity traumatic brain injury and are managed non-operatively. Subdural and intraventricular supratentorial hemorrhages carry the highest risk of mortality. Abstract: The characteristics of blunt traumatic supratentorial cranial bleed (STCB) types have not been directly compared. The National Trauma Data Bank (NTDB) 2014 was queried for adults with an isolated single STCB n = 57, 278. Patients were grouped by STCB categories: subdural (SDH), subarachnoid (SAH), epidural (EDH), intraparenchymal (IPH), and intraventricular hemorrhage (IVH). Frequency, demographics, clinical characteristics, procedures, and outcomes were compared among groups. SDH was the most common STCB (53%) and occurred mostly in elderly patients after a fall (78%), 30% underwent craniotomy and their mortality was 7%. SAH occurred in 32% of patients and carried the lowest mortality (3%). SAH were least likely to have a severe brain injury (7%), and had the lowest Injury Severity Score (ISS, median 8) and complication rate (1%), as well as the shortest hospital length of stay (HLOS, 4.6 ± 6.4 days). EDH was uncommon (2%), occurred in younger patients (median 35 years), and had the highest percentage of traffic related injuries (28%). While EDH patients presented with the poorest neurological status (16% Glasgow Coma Scale ≤ 8, ISS median 18) and were operated on more than any other STCB type (51%), their mortality was lower (4%) and they had the highest discharge to home rate (71%). IVH was the least common (2%), but most lethal (9%) STCB type. These patients had the highest HLOS and intensive care unit LOS, and the lowest craniotomy rate (21%). STCB types have different clinical course, and outcomes. Understanding these differences can be useful in managing patients with STB.