Identification of Demographic and Clinical Prognostic Factors in Traumatic Intraventricular Hemorrhage

Abby K Scurfield; Machelle D Wilson; Gene Gurkoff; Ryan Martin; Kiarash Shahlaie

doi:10.1007/s12028-022-01587-z

Identification of Demographic and Clinical Prognostic Factors in Traumatic Intraventricular Hemorrhage

Neurocrit Care. 2023 Feb;38(1):149-157. doi: 10.1007/s12028-022-01587-z. Epub 2022 Sep 1.

Authors

Abby K Scurfield¹, Machelle D Wilson², Gene Gurkoff³, Ryan Martin^{3

4}, Kiarash Shahlaie⁵

Affiliations

¹ Frank H. Netter M.D. School of Medicine, Quinnipiac University, 830 Orange Street, New Haven, CT, 06511, USA.
² Division of Biostatistics, Department of Public Health Sciences, Davis Clinical and Translational Science Center, University of California, 2921 Stockton Blvd., Suite 1400, Sacramento, CA, 95817, USA.
³ Department of Neurological Surgery, University of California, 4860 Y Street, Suite 3740,, 95817, Davis, Sacramento, CA, USA.
⁴ Department of Neurology, University of California, 4860 Y Street, Suite 3740,, Davis, Sacramento, CA, USA.
⁵ Department of Neurological Surgery, University of California, 4860 Y Street, Suite 3740,, 95817, Davis, Sacramento, CA, USA. krshahlaie@ucdavis.edu.

Abstract

Background: The presence of traumatic intraventricular hemorrhage (tIVH) following traumatic brain injury (TBI) is associated with worse neurological outcome. The mechanisms by which patients with tIVH have worse outcome are not fully understood and research is ongoing, but foundational studies that explore prognostic factors within tIVH populations are also lacking. This study aimed to further identify and characterize demographic and clinical variables within a subset of patients with TBI and tIVH that may be implicated in tIVH outcome.

Methods: In this observational study, we reviewed a large prospective TBI database to determine variables present on admission that predicted neurological outcome 6 months after injury. A review of 7,129 patients revealed 211 patients with tIVH on admission and 6-month outcome data. Hypothesized risk factors were tested in univariate analyses with significant variables (p < 0.05) included in logistic and linear regression models. Following the addition of either the Rotterdam computed tomography or Glasgow Coma Scale (GCS) score, we employed a backward selection process to determine significant variables in each multivariate model.

Results: Our study found that that hypotension (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.13-0.94, p = 0.04) and the hemoglobin level (OR = 1.33, 95% CI = 1.09-1.63, p = 0.006) were significant predictors in the Rotterdam model, whereas only the hemoglobin level (OR = 1.29, 95% CI = 1.06-1.56, p = 0.01) was a significant predictor in the GCS model.

Conclusions: This study represents one of the largest investigations into prognostic factors for patients with tIVH and demonstrates that admission hemoglobin level and hypotension are associated with outcomes in this patient population. These findings add value to established prognostic scales, could inform future predictive modeling studies, and may provide potential direction in early medical management of patients with tIVH.

Keywords: Intraventricular hemorrhage; Prognostic model; Trauma; Traumatic brain injury.

Publication types

Review
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Brain Injuries, Traumatic* / complications
Brain Injuries, Traumatic* / epidemiology
Cerebral Hemorrhage / complications
Cerebral Hemorrhage / diagnostic imaging
Cerebral Hemorrhage / epidemiology
Demography
Glasgow Coma Scale
Hemoglobins
Humans
Observational Studies as Topic
Prognosis
Prospective Studies
Treatment Outcome

Substances

Hemoglobins

Grants and funding

UL1 TR001860/TR/NCATS NIH HHS/United States