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Matthias Oertel, Daniel F. Kelly, David McArthur, W. John Boscardin, Thomas C. Glenn, Jae Hong Lee, Tooraj Gravori, Dennis Obukhov, Duncan Q. McBride and Neil A. Martin

. Results Rates of PHI by Patient Group and Lesion Type A total of 142 patients (mean age 34 ± 14 years, male/female ratio 4.3:1, median admission GCS score of 8) were included in this study. The mean time from the injury to the first CT scan was 2 ± 1.6 hours, and the mean time between the first and second CT scan was 6.9 ± 3.6 hours. Progressive hemorrhagic injury was present in 60 patients (42.3%). Of 107 patients in whom a first CT scan was performed within 2 hours of injury, 48.6% demonstrated PHI on their second CT scan, accounting for 87% of all patients in

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clinical significance of progressive hemorrhagic injury (PHI). Methods. The diagnosis of PHI was determined by comparing the first and second CT scans and was categorized as epidural hematoma (EDH), subdural hematoma (SDH), intraparenchymal contusion or hematoma (IPCH), or subarachnoid hemorrhage (SAH). Potential risk factors, the daily mean intracranial pressure (ICP), and cerebral perfusion pressure were analyzed. In a cohort of 142 patients (mean age 34 ± 14 years; median Glasgow Coma Scale score of 8, range 3–15; male/female ratio 4.3:1), the mean time from injury

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, 3, 7 MD 11 2016 125 5 1217 1228 10.3171/2015.7.JNS15809 2015.7.JNS15809 Progressive hemorrhagic injury after severe traumatic brain injury: effect of hemoglobin transfusion thresholds Aditya Vedantam 1 MD Jose-Miguel Yamal 2 PhD Maria Laura Rubin 2 MS Claudia S. Robertson 1 MD Shankar P. Gopinath 1 MD 11 2016 125 5 1229 1234 10.3171/2015.11.JNS151515 2015.11.JNS151515 Intraoperative premature rupture of middle cerebral artery aneurysms: risk factors and sphenoid ridge proximation sign Jaechan Park 1, 2 MD, PhD Wonsoo Son 1, 2 MD Ki-Su Park 1, 2 MD Dong

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Aditya Vedantam, Jose-Miguel Yamal, Maria Laura Rubin, Claudia S. Robertson and Shankar P. Gopinath

P rogression of intracranial injury on CT is reported in 8%–67% of patients with blunt traumatic brain injury (TBI). 22 Studies focusing on parenchymal contusions show that progressive hemorrhagic injury occurs in more than 50% of the patients on repeat CT scans. 9 , 14 For the majority of patients with TBI, progression of injury is observed in the first 24–48 hours, 1 , 14 although a few patients can show progression as long as 72 hours after injury. 6 These events are associated with increased morbidity and mortality as well as poorer neurological

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Svetlana Kvint, James Schuster and Monisha A. Kumar

: Predicting progressive hemorrhagic injury from isolated traumatic brain injury and coagulation . Surgery 158 : 655 – 661 , 2015 26067457 10.1016/j.surg.2015.02.029 12 Frontera JA , Provencio JJ , Sehba FA , McIntyre TM , Nowacki AS , Gordon E , : The role of platelet activation and inflammation in early brain injury following subarachnoid hemorrhage . Neurocrit Care 26 : 48 – 57 , 2017 10.1007/s12028-016-0292-4 27430874 13 Garcia D , Barrett YC , Ramacciotti E , Weitz JI : Laboratory assessment of the anticoagulant effects of the next

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Joseph A. Carnevale, David J. Segar, Andrew Y. Powers, Meghal Shah, Cody Doberstein, Benjamin Drapcho, John F. Morrison, John R. Williams, Scott Collins, Kristina Monteiro and Wael F. Asaad

Crescito V , Ransohoff J : Ethanol potentiation of central nervous system trauma . J Neurosurg 46 : 328 – 335 , 1977 839257 10.3171/jns.1977.46.3.0328 12 Flierl MA , Stoneback JW , Beauchamp KM , Hak DJ , Morgan SJ , Smith WR , : Femur shaft fracture fixation in head-injured patients: when is the right time? J Orthop Trauma 24 : 107 – 114 , 2010 10.1097/BOT.0b013e3181b6bdfc 20101135 13 Folkerson LE , Sloan D , Cotton BA , Holcomb JB , Tomasek JS , Wade CE : Predicting progressive hemorrhagic injury from isolated

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Thara Tunthanathip, Kanutpon Khocharoen and Nakornchai Phuenpathom

, Lu X , : Activity of factor VII in patients with isolated blunt traumatic brain injury: association with coagulopathy and progressive hemorrhagic injury . J Trauma Acute Care Surg 76 : 114 – 120 , 2014 24368365 10.1097/TA.0b013e3182a8fe48 31 Zhang J , Jiang R , Liu L , Watkins T , Zhang F , Dong JF : Traumatic brain injury-associated coagulopathy . J Neurotrauma 29 : 2597 – 2605 , 2012 10.1089/neu.2012.2348 23020190

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Jade-Marie Corbett, Kwok M. Ho and Stephen Honeybul

YR , Wu X , Yu J , Li ZQ , Du ZY , : Coagulopathy in traumatic brain injury and its correlation with progressive hemorrhagic injury: a systematic review and meta-analysis . J Neurotrauma 33 : 1279 – 1291 , 2016 10.1089/neu.2015.4205 26850305 21 Yuan Q , Yu J , Wu X , Sun YR , Li ZQ , Du ZY , : Prognostic value of coagulation tests for in-hospital mortality in patients with traumatic brain injury . Scand J Trauma Resusc Emerg Med 26 : 3 , 2018 29304855 10.1186/s13049-017-0471-0

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Xueyan Wan, Chao Gan, Chao You, Ting Fan, Suojun Zhang, Huaqiu Zhang, Sheng Wang, Kai Shu, Xiong Wang and Ting Lei

T raumatic brain injury (TBI) remains a leading cause of death, neurological sequelae, and long-term disability. Approximately 23.1%–64% of patients with TBI 5 , 34 , 42 experience progressive hemorrhagic injury (PHI), as confirmed on serial CT scanning, 31 and it affects their outcome. 8 , 17 , 42 With the aim of achieving early prediction of PHI and improving the outcome of these patients, many clinical factors have been identified as predictors of PHI, including so-called spot signs, 6 , 31 leakage signs, 24 and coagulopathy. 8 , 17 , 21 , 34 However