Incidence of Delayed Intracranial Hemorrhage in Moderate-risk Mild Traumatic Brain Injury with Normal Initial Brain Computed Tomography in The Emergency Department
Keywords:
mild traumatic brain injury, emergency department, computed tomography, delayed intracranial hemorrhageAbstract
Background: Mild traumatic brain injury (mTBI) is a common condition encountered in emergency departments. Patients with moderate-risk mTBI are often admitted for observation even when initial brain computed tomography (CT) is normal due to concerns about delayed intracranial hemorrhage. However, the actual incidence of delayed hemorrhage in this population remains unclear
Objective: To determine the incidence of in-hospital delayed intracranial hemorrhage before hospital discharge in moderate-risk mTBI patients with normal initial brain CT performed in the emergency department
Materials and Methods: This retrospective observational study included patients with moderate-risk mTBI who had a normal initial brain CT and were admitted for observation. Clinical characteristics, mechanism of injury, and time to brain CT were collected. Patients were followed during hospitalization to identify cases of delayed intracranial hemorrhage
Results: A total of 419 patients were included in the study. The median age was 46 years (IQR 26.5-61), and 55.9% were male. Most patients had initial Glasgow coma scale score of 15 (90.7%). The common mechanism of injury was motorcycle accidents (61.8%). The median time from injury to brain CT was 143 minutes (IQR 91.5-248.5). Four patients (1%) developed clinical deterioration and underwent repeat brain CT ; however, the incidence of delayed intracranial hemorrhage was 0% (95%CI, 0.0%-0.88%).
Conclusion: Delayed intracranial hemorrhage in moderate-risk mTBI patients with normal initial brain CT is extremely rare. Selected patients may be safely discharged from the emergency department with appropriate clinical observation and follow-up instructions.
References
Nakornchai P, Thiradej K. Clinical practice guideline for traumatic brain injury. Bangkok: The Royal College of Neurosurgeons of Thailand; 2019.
Geijerstam JL, Britton M. Mild head injury—mortality and complication rate: meta-analysis of findings in a systematic literature review. Acta Neurochir (Wien). 2003;145:843-50.
Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16:987-1048.
Bonney PA, Briggs A, Briggs RG, et al. Rate of intracranial hemorrhage after minor head injury. Cureus. 2020;12(9):e10653.
Aramvanitch S, Tunthanathip T, Kaewborisutsakul A, et al. Validation of mild TBI risk score to predict intracranial hemorrhage in cases of mild traumatic brain injury in Thailand. Trauma Surg Acute Care Open. 2020;5:e000483.
Santing JAL, van Gent M, van den Brand CL, Jellem K. Hospital admission of older patients with mild traumatic brain injury and traumatic intracranial hemorrhage: is it necessary? Eur J Trauma Emerg Surg. 2025.
Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357:1391-6.
Smits M, Dippel DWJ, de Haan GG, et al. External validation of Canadian CT Head Rule and the New Orleans Criteria for CT scanning in patients with minor head injury. JAMA. 2005;294(12):1519-25.
Haydel MJ, Preston CA, Mills TJ, et al. Indications for CT in patients with minor head injury. N Engl J Med. 2000;343:100-5.
Geijerstam JL, Oredsson S, Britton M. Medical outcome after immediate computed tomography or admission for observation in patients with mild traumatic brain injury. BMJ. 2006;333:465.
Jagoda AS, Bazarian JJ, Bruns JJ Jr, et al. Clinical policy: neuroimaging and decision making in adult mild traumatic brain injury in the acute setting. Ann Emerg Med. 2008;52:714-48.
Livingston DH, Lavery RF, Passannante MR, et al. Emergency department discharge of patients with a negative cranial computed tomography scan after minimal head injury. Ann Surg. 2000;232(1):126-32.
Almenawer SA, Bogza I, Yarascavitch B, et al. Management of mild traumatic brain injury with intracranial hemorrhage: a systematic review and meta-analysis. Neurosurgery. 2013;73(4):546-56.
Isokuortti H, Luoto TM, Kataja A, et al. Necessity of monitoring after negative head CT in acute head injury. Injury. 2014;45(9):1340-4.
Chairattanawan P, Angkoontassaneeyarat C, Yuksen C, Jenpanitpong C, Phontabtim M, Laksanamapune T. Early discharge versus 6-hour observation in mild traumatic brain injury with normal brain CT scan: a comparative pilot study of outcomes. Arch Acad Emerg Med. 2024;12(1):e50.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
เนื้อหาและข้อมูลในบทความที่ลงตีพิมพ์ในมหาราชนครศรีธรรมราชเวชสาร ถือเป็นข้อคิดเห็นและความรับผิดชอบของผู้เขียนบทความโดยตรงซึ่งกองบรรณาธิการวารสาร ไม่จำเป็นต้องเห็นด้วย หรือร่วมรับผิดชอบใด ๆ
บทความ ข้อมูล เนื้อหา รูปภาพ ฯลฯ ที่ได้รับการตีพิมพ์ในมหาราชนครศรีธรรมราชเวชสาร ถือเป็นลิขสิทธิ์ของมหาราชนครศรีธรรมราชเวชสาร หากบุคคลหรือหน่วยงานใดต้องการนำทั้งหมดหรือส่วนหนึ่งส่วนใดไปเผยแพร่ต่อหรือเพื่อกระทำการใด จะต้องได้รับอนุญาตเป็นลายลักษณ์อักษรจากวารสารมหาราชนครศรีธรรมราชเวชสาร ก่อนเท่านั้น
