Incidence of traumatic intracranial hemorrhage expansion after stable repeat head imaging: A retrospective cohort study

Introduction: Patients with traumatic intracranial hemorrhage (tICH) often require intensive care unit (ICU) admission until bleeding stability is demonstrated through interval head computed tomography (HCT). The brain injury guidelines (BIG) suggest a minimum 24-h ICU admission for severe patients (BIG 3) regardless of repeat CT stability. We sought to evaluate the rate of tICH expansion after an initial stable interval scan was obtained. Methods: A single-center retrospective cohort study at a level 1 trauma center was performed. All adult patients with tICH evaluated using BIG criteria were included. The primary endpoint was incidence of tICH expansion after initial stability on interval HCT performed at approximately 6 h. Secondary endpoints included time to tICH stability, frequency of neurosurgical intervention, and time to surgical intervention. Results: A total of 1517 patients met inclusion criteria. Of the 1121 patients with repeat imaging, 288 (25.7%) experienced progression with 94.4% detected on the initial 6-h interval scan. Of all patients with initially stable repeat imaging (n = 833), progression occurred in 16 (1.9%) patients. Of these patients, 5 required neurosurgical intervention, 4 received increased monitoring, 2 transitioned to comfort measures and 5 had no change in management. The median time from initial scan to expansion in these patients was 42.2 h. Median time to surgical intervention after post-stability expansion was 102 h. Conclusion: Patients who demonstrate bleeding stability on first interval HCT after tICH rarely experience expansion. Consideration should be given to discharging patients from the ICU when initial interval HCT shows no progression.