Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Assessment of the Clinical and the Radiological Prognostic Factors that Determine the Management of a Delayed, Traumatic, Intraparenchymal Hemorrhage (DTIPH)

지연성 외상성 뇌실질내 출혈 환자의 치료를 결정하는 임상적, 영상학적 예후인자에 대한 평가

  • Ryu, Je Il (Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine) ;
  • Kim, Choong Hyun (Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine) ;
  • Kim, Jae Min (Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine) ;
  • Cheong, Jin Hwan (Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine)
  • 류제일 (한양대학교 의과대학 한양대학교 구리병원 신경외과) ;
  • 김충현 (한양대학교 의과대학 한양대학교 구리병원 신경외과) ;
  • 김재민 (한양대학교 의과대학 한양대학교 구리병원 신경외과) ;
  • 정진환 (한양대학교 의과대학 한양대학교 구리병원 신경외과)
  • Received : 2015.11.02
  • Accepted : 2015.12.11
  • Published : 2015.12.31
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Abstract

Purpose: Delayed, traumatic, intraparenchymal hemorrhage (DTIPH) is a well-known contributing factor to secondary brain damage that evokes severe brain edema and intracranial hypertension. Once it has occurred, it adversely affects the patient's outcome. The aim of this study was to evaluate the prognosis factors for DTIPH by comparing clinical, radiological and hematologic results between two groups of patients according to whether surgical treatment was given or not. Methods: The author investigated 26 patients who suffered DTIPH during the recent consecutive five-year period. The 26 patients were divided according to their having undergone either a decompressive craniectomy (n=20) or continuous conservative treatment (n=6). A retrospective investigation was done by reviewing their admission records and radiological findings. Results: This incidence of DTIPH was 6.6% among the total number of patients admitted with head injuries. The clinical outcome of DTIPH was favorable in 9 of the 26 patients (34.6%) whereas it was unfavorable in 17 patients (65.4%). The patients with coagulopathy had an unexceptionally high rate of mortality. Among the variables, whether the patient had undergone a decompressive craniectomy, the patient's preoperative clinical status, and the degree of midline shift had significant correlations with the ultimate outcome. Conclusion: In patients with DTIPH, proper evaluation of preoperative clinical grading and radiological findings can hamper deleterious secondary events because it can lead to a swift and proper decompressive craniectomy to reduce the intracranial pressure. Surgical decompression should be carefully selected, paying attention to the patient's accompanying injury and hematology results, especially thrombocytopenia, in order to improve the patient's neurologic outcomes.

Keywords

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