V. Pandit1, P. Rhee1, N. Kulvatunyou1, A. Tang1, T. O’Keeffe1, L. Gries1, G. Vercruysse1, R. Latifi1, R. S. Friese1, B. Joseph1 1University Of Arizona,Trauma Surgery,Tucson, AZ, USA
Introduction: The size of the intracranial hemorrhage (ICH) in patients with traumatic brain injury is an important determinant for neurosurgical intervention (NI). However; the optimum size for NI remains unclear. The aim of this study was to define the optimum size of isolated ICH (epidural [EDH] or SDH [SDH]) for NI in patients with TBI.
Methods: We performed a 5 year retrospective analysis of a prospectively collected database of all patients with an isolated EDH or SDH to our level 1 trauma center. The outcome measure was need for neurosurgical intervention. . Neurosurgical intervention was defined as craniotomy and/or craniectomy. Receiver operating characteristic (ROC) curves were plotted to identify the optimal ICH size for EDH and SDH for need for neurosurgical intervention. Sub-analysis was performed for patient on antiplatelet/anti-coagulation therapy (AP/AC).
Results: A total of 905 patients (isolated SDH: 729, isolated EDH: 176) were included of which; 21.2% (n=192) patients underwent NI. In patients with SDH, size of 6 mm was the optimum threshold for NI (AUC: 0.80, p=0.01) while in patient with EDH, size of 6.5 mm optimum threshold for NI (AUC: 0.78, p=0.01).
On multivariate regression analysis after adjusting for demographics, neurological examination, AP/AC therapy, injury severity, patient with SDH≥6 were 3.9 times (OR: 3.9, CI: 2.5-5.2) more likely while patient with EDH ≥ 6.5 were 3 times (OR: 3, CI: 1.7-4.9) more likely to have neurosurgical intervention
On sub-analysis of patients on AC/AP therapy, size of 4.5 mm was the optimum threshold for NI for both patients with SDH (AUC: 0.79, p=0.001) and EDH (AUC: 0.77, p=0.02).
Conclusion:Our study defines the optimal size of ICH in patients with isolated SDH and EDH for the need for NI. In patient with SDH/EDH 6mm is the optimal threshold determining the need for NI while it is lower at 4.5mm in patient on AP/AC therapy. This will help establish guidelines based on the size of ICH for better defining the criteria for NI in patients with TBI and isolated ICH.