Research Reports - Hematoma enlargement among patients with traumatic brain injury

J Vasc Interv Neurol. 2015 Jul;8(3):42-9

Qureshi AI(1), Malik AA(1), Adil MM(1), Defillo A(2), Sherr GT(2), Suri MF(2)

Observational studies suggest that hematomas continue to enlarge during
hospitalization in patients with traumatic brain injury (TBI). There is limited
data regarding factors associated with hematoma enlargement and on whether
hematoma enlargement contributes directly to death and disability in patients
with TBI. We analyzed data collected as part of the Resuscitation Outcomes
Consortium Hypertonic Saline and TBI Study. Hematoma enlargement was ascertained
and collected as a predefined safety endpoint. We evaluated the effect of
hematoma enlargement on the risk of death and disability at 6 months based on the
Extended Glasgow Outcome Scale (GOSE) (dichotomized as >4 or ≤4) using stepwise
logistic regression analysis. We adjusted for age (continuous variable),
admission GCS score (dichotomized at >5 and ≤5), and computed tomography (CT)
scan classification (Marshall grades entered as a categorical variable). Of the
1200 patients with severe TBI analyzed, 238 (19.8%) patients were reported to
have hematoma enlargement as an adverse event. The proportion of patients who
reached favorable outcome at 6 months was significantly lower (defined by GOSE of
>4) among patients with hematoma enlargement (29.0% vs. 40.1%, p<.0001). The
proportion of patients who died within 6 months was significantly higher among
patients with hematoma enlargement (31.9% vs. 20.7%, p<.0001). After adjusting
for age, admission GCS score, and initial injury score, the odds of favorable
outcome was lower in patients with hematoma enlargement (odds ratio 0.7, 95%
confidence interval [CI]; 0.5-0.97). Our results suggest that hematoma
enlargement may be a direct contributor to death and disability in patients with
TBI at 6 months. Future clinical trials must continue to evaluate new therapeutic
interventions aimed at reducing hematoma enlargement with a favorable risk
benefit ratio in patients with TBI.

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