Cranial computed tomography abnormalities, complications and therapeutic outcomes in mild traumatic brain injury patients

Pakpume Bumrungrachpukdee; Pongtrip  Unprasert

Authors

Pakpume Bumrungrachpukdee Department of Surgery, Faculty of Medicine, Burapha University, Chonburi, Thailand
Pongtrip Unprasert Department of Surgery, Faculty of Medicine, Burapha University, Chonburi, Thailand

Keywords:

Cranial computed tomography, CT brain scan, mild traumatic brain injury, cranial CT abnormalities, CT brain abnormality, clinical outcomes of mild traumatic brain injury patients.

Abstract

Background: Traumatic brain injury (TBI) is a major cause of death and disability in Thailand, primarily due to motorcycle accidents.

Objectives: This study examines the characteristics, incidence, cranial CT abnormalities, complications, and outcomes of mild TBI (mTBI) patients

Materials and Methods: This retrospective cross-sectional study analyzed mTBI patients treated at Burapha University Hospital from June 2020 to August 2021. Data on patient demographics, injury mechanisms, cranial CT findings, outcomes, and complications were collected and analyzed. The study aimed to determine the incidence of cranial CT abnormalities, clinical outcomes, and risk factors for cranial CT abnormality in mTBI patients with Canadian CT head rule combined with New Orleans Criteria.

Results: Analyzed 665 mTBI patients. Cranial CT abnormalities were found in 15.8% of patients, with subarachnoid hemorrhage (46.7%) and subdural hematoma (33.3%) being the most common findings. Risk factors significantly associated with abnormal cranial CT included motorcycle accidents (p = 0.0002), falls (p = 0.0002), loss of consciousness (p = 0.00003), amnesia (p < 0.00001), and lower GCS scores (p < 0.00001). Three patients (0.45%) required neurosurgical intervention, all of whom were young males involved in motorcycle accidents with alcohol intoxication. The overall favorable outcome rate was 99.85%, with only one mortality (0.15%) due to associated thoracoabdominal injuries with hypotension.

Conclusion: This study highlights key risk factors for intracranial abnormalities in mTBI patients and underscores the importance of targeted cranial CT criteria, preventive measures, and timely management of associated injuries. Further research is needed to explore long-term outcomes and optimize management strategies for mTBI patients.

References

Menon DK, Schwab K, Wright DW, Maas AI. Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil. 2010; 91: 1637-40.

World Health Organization. ICD-10: International Statistical Classification of Diseases and Related Health Problems Tenth Revision. Version: 2016. 2016.

Division of injury prevention, Bureau of non-communicable diseases, Department of disease control, Ministry of public health, Thailand. Road traffic mortality and mortality rate per 100 000 population in Thailand 2014-2016. 2017.

Division of injury prevention, Bureau of non-communicable diseases, Department of disease control, Ministry of public health, Thailand. Road traffic accident in Thailand 2016. 2017.

Division of injury prevention, Bureau of non-Communicable diseases, Department of disease control, Ministry of public health, Thailand. Head injury study report in injured and deceased patients from motorcycle accidents–inpatients in Thailand 2009-2011. 2012.

Dissemination academic section, Division of epidemiology, Bureau of non-communicable diseases, Department of disease control, Ministry of public health, Thailand. Severe injuries related to motorcycle accident in Thailand, 2012. Weekly Epidemiological Surveillance Report (WESR). 2013; 44: 481-4.

Division of epidemiology, Bureau of non-communicable diseases, Department of disease control, Ministry of public health, Thailand. Severe injuries from falls. Summary of the 2015 Disease Surveillance Report. 2016.

Carroll LJ, Cassidy JD, Holm L, Kraus J, Coronado VG, WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med. 2004; 43: 113–25.

Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001; 357: 1391–6.

Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000; 343: 100–5.

Peeters W, van den Brande R, Polinder S, Brazinova A, Steyerberg EW, Lingsma HF, et al. Epidemiology of traumatic brain injury in Europe. Acta Neurochir (Wien). 2015; 157: 1683-96.

Peterson AB, Xu L, Daugherty J, Breiding MJ. Surveillance report of traumatic brain injury-related emergency department visits, hospitalizations, and deaths—United States, 2014 [Internet]. Atlanta (GA): Centers for Disease Control and Prevention (US); 2019 [accessed Nov 20, 2025]. 23 p. Available from: https://www.cdc.gov/traumaticbraininjury/pdf/TBI-Surveillance-Report-FINAL_508.pdf

Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2: 81–4.

Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 305: 480-4.

Prexl O, Bruckbauer M, Voelckel W, Grottke O, Ponschab M, Maegele M, Schöchl H. The impact of direct oral anticoagulants in traumatic brain injury patients greater than 60-years-old. Scand J Trauma Resusc Emerg Med. 2018; 26: 20.

Campiglio L, Bianchi F, Cattalini C, Belvedere D, Rosci CE, Casellato CL, et al. Mild brain injury and anticoagulants: Less is enough. Neurol Clin Pract. 2017; 7: 296-305.