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Progressive neurological deterioration in mild traumatic brain injury with acute intracranial hemorrhage: a single center, retrospective observational comparative study
Jung-hoon Kim2, Jae-Sung Park2, Byung-chul Son2, Sin-soo Jeon2, Kwan-Sung Lee2, Yong Sam Shin2, Jin-gyu Choi1
Correspondence  Jin-gyu Choi ,Tel: 82-2-2258-6351, Fax: 82-2-594-4248, Email: toughan@naver.com
Received: July 7, 2018;  Accepted: July 23, 2018.  Published online: July 23, 2018.
Objectives: To assess the rate of acute neurological aggravation of mild traumatic brain injury (TBI) patients, and to compare the deterioration frequency between categorized admission characteristics groups and the mean values between deteriorated and non-deteriorated groups.
From January 2014 to August 2017, medical records of mild TBI patients having GCS 13 or more on arrival were retrospectively reviewed. Their admission characteristics and neurological outcome of the first treatment week were analyzed. We compared the frequency of progressive deteriorated patients between independent variable groups and also compared mean value of admission characteristics between deteriorated and non-deteriorated groups.
193 patients were included in this study. 22 showed neurological aggravation in the first treatment week. Mean age was 64.89 ± 17.36 and subdural hematoma (SDH, n=82, 42.49%) was the most frequent CT finding as a main lesion. The thickness of EDH or SDH, midline shift and compression of basal cistern in the initial CT scan were significant factors of progressive deterioration, whereas the volume of ICH showed no significance. In laboratory tests, deteriorated group had low hemoglobin level and higher WBC count. However, the initial vital signs did not significantly affect the outcome.
In this study, progressive mental deterioration of mild TBI with acute intracranial hemorrhage was not rare (11.40%). The mass effect of EDH or SDH in the initial CT scan, and in addition to coagulopathy, leukocytosis, anemia in the laboratory tests showed to have effect on neurologic aggravation. Systolic blood pressure and body temperature, which have been considered important in managing severe TBI patients, showed no significance on early outcome in mild TBI patients.
Key words: Computed Tomography; Laboratory test; Outcome; Prediction; Prognosis; Traumatic brain injury
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