Characterizing the type and location of intracranial abnormalities in mild traumatic brain injury

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OBJECTIVE

The incidence of intracranial abnormalities after mild traumatic brain injury (TBI) varies widely across studies. This study describes the characteristics of intracranial abnormalities (acute/preexisting) in a large representative sample of head-injured patients who underwent CT imaging in an emergency department.

METHODS

CT scans were systematically analyzed/coded in the TBI Common Data Elements framework. Logistic regression modeling was used to quantify risk factors for traumatic intracranial abnormalities in patients with mild TBIs. This cohort included all patients who were treated at the emergency department of the Tampere University Hospital (between 2010 and 2012) and who had undergone head CT imaging after suffering a suspected TBI (n = 3023), including 2766 with mild TBI and a reference group with moderate to severe TBI.

RESULTS

The most common traumatic lesions seen on CT scans obtained in patients with mild TBIs and those with moderate to severe TBIs were subdural hematomas, subarachnoid hemorrhages, and contusions. Every sixth patient (16.1%) with mild TBI had an intracranial lesion compared with 5 of 6 patients (85.6%) in the group with moderate to severe TBI. The distribution of different types of acute traumatic lesions was similar among mild and moderate/severe TBI groups. Preexisting brain lesions were a more common CT finding among patients with mild TBIs than those with moderate to severe TBIs. Having a past traumatic lesion was associated with increased risk for an acute traumatic lesion but neurodegenerative and ischemic lesions were not. A lower Glasgow Coma Scale score, male sex, older age, falls, and chronic alcohol abuse were associated with higher risk of acute intracranial lesion in patients with mild TBI.

CONCLUSIONS

These findings underscore the heterogeneity of neuropathology associated with the mild TBI classification. Preexisting brain lesions are common in patients with mild TBI, and the incidence of preexisting lesions increases with age. Acute traumatic lesions are fairly common in patients with mild TBI; every sixth patient had a positive CT scan. Older adults (especially men) who fall represent a susceptible group for acute CT-positive TBI.

ABBREVIATIONS CDE = Common Data Element; DAI = diffuse axonal injury; ED = emergency department; GCS = Glasgow Coma Scale; LOC = loss of consciousness; MTBI = mild traumatic brain injury; PTA = posttraumatic amnesia; WHO = World Health Organization.

Article Information

Correspondence Harri Isokuortti: University of Tampere, Finland. harri. isokuortti@gmail.com.

INCLUDE WHEN CITING Published online January 12, 2018; DOI: 10.3171/2017.7.JNS17615.

Disclosures Professor Iverson is a consultant for NeuroHealth Research and Rehabilitation, Inc. and NeuroHealth, LLC.

© AANS, except where prohibited by US copyright law.

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Figures

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    Graph comparing incidence of intracranial lesions by age in the whole cohort (n = 3023). Gray line indicates acute intracranial lesions; black line indicates preexisting intracranial abnormality.

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