Traumatic Intracerebral Hemorrhage: Prognostic Factors and Outcomes

Abstract

BACKGROUND: Traumatic brain injury (TBI) is a significant health and socioeconomic issue. Traumatic intracerebral hemorrhage (TICH), a frequent consequence of TBI, is more frequent than traumatic extra parenchymal hemorrhage. It is reported to be linked with bad prognosis and can cause physical, mental, and cognitive impairment that might last a lifetime.OBJECTIVE: The aim of this study was to identify prognostic factors in patients suffering from traumatic intracerebral hemorrhage and compare patients with favorable and unfavorable outcomes.METHODS: This prospective study included 156 patients with traumatic intracerebral hemorrhage who were admitted at Alexandria Main University hospital from the 1st of February 2023 to the 31st of January 2024. During their hospital stay they were followed clinically and radiologically, also their modes of treatment were assessed. Upon discharge patients were evaluated using the Glasgow outcome score (GOS), those with GOS of 1 to 3 were classified as unfavorable outcome while those with GOS of 4 to 5 were classified as favorable outcome. Finally, both groups were compared.RESULTS: We observed that among patients with traumatic intracerebral hemorrhage, 131 (83.97%) were male, while 25 (16.03%) were females. Frontal (49.4%) and temporal (28.2%) lobes showed predominance for the location of the lesion. According to the Glasgow coma scale (GCS) on admission, 31 (19.9%) patients had severe TBI, 29 (18.6%) patients had moderate TBI and 96 (61.5%) patients had mild TBI. One hundred twenty-four (79.49%) patients underwent non-surgical treatment while 32 (20.51%) patients underwent surgical treatment. On discharge, according to the Glasgow outcome score, 36 (23.1%) patients has unfavorable outcome and 120 (76.9%) had a favorable outcome. Low GCS score on admission, lesion volume, increase in TICH volume, coexistence of TICH with subarachnoid and subdural hemorrhage, brain edema, increase in midline shift, altered coagulation profile and elevated liver enzymes showed a statistically significant correlation with unfavorable outcome.CONCLUSION: In patients with traumatic intracerebral hemorrhage, lower GCS score on admission, lesion volume, progression of the lesion, coexistence of TICH with subarachnoid and subdural hemorrhage, brain edema, increase in midline shift, coagulopathy and elevated liver enzymes are associated with poor prognosis. Patients with these conditions tend to require surgical management with relatively longer hospital stays.