Incidence, risk factors, and clinical outcomes of acute brain swelling associated with traumatic acute subdural hematoma: a retrospective study utilizing novel diagnostic criteria

Shilong Fu; Haibing Liu; Guofeng Wang; Xiaofang Hu; Shousen Wang

doi:10.1177/17562864241242944

Incidence, risk factors, and clinical outcomes of acute brain swelling associated with traumatic acute subdural hematoma: a retrospective study utilizing novel diagnostic criteria

Ther Adv Neurol Disord. 2024 Apr 17:17:17562864241242944. doi: 10.1177/17562864241242944. eCollection 2024.

Authors

Shilong Fu^{1

2}, Haibing Liu^{1

3}, Guofeng Wang², Xiaofang Hu³, Shousen Wang^{4

3

5}

Affiliations

¹ Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China.
² Department of Neurosurgery, The First Hospital of Putian City, Putian, China.
³ Department of Neurosurgery, Fuzhou 900th Hospital, Fuzhou, China.
⁴ Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University Fuzhou, Fujian 350025, China.
⁵ Fujian Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Neurovascular Diseases, Fuzhou, China.

Abstract

Background: Post-traumatic acute brain swelling (ABS) is a major cause of elevated intracranial pressure and thus mortality. The current definition of post-traumatic ABS has certain limitations, and there is limited information available regarding ABS associated with traumatic acute subdural hematoma (ASDH).

Objectives: To investigate the incidence, risk factors, and clinical outcomes of ABS associated with traumatic ASDH.

Design: Retrospective study.

Methods: Data for 161 patients diagnosed with traumatic ASDH were retrospectively collected. Novel computed tomography-based criteria were proposed for diagnosing ABS in patients with ASDH and determining its incidence. Univariate and multivariate logistic regression analyses were performed to explore the risk factors of post-traumatic ABS. The Glasgow Outcome Scale (GOS) score, mortality, and functional prognosis of all patients at discharge and the proportion of intraoperative malignant brain bulge in surgical patients were taken as clinical outcome measures.

Results: A total of 45 (28%) patients experienced post-traumatic ABS, exhibiting significantly lower Glasgow Coma Scale scores on admission (p < 0.001). The incidence of hemispheric and whole-brain swelling was 8.1% and 19.9%, respectively. Risk factors independently associated with post-traumatic ABS were: (1) age [odds ratio (OR) = 0.917, p < 0.001]; (2) platelet to white blood cell ratio (PWR) (OR = 0.887, p = 0.012); and (3) traumatic subarachnoid hemorrhage (SAH) (OR = 4.346, p = 0.005). The ABS cohort had a lower GOS score [2 (1-3) versus 4 (3-5); p < 0.001], higher mortality (46.7% versus 6.9%; p < 0.001), and higher proportion of unfavorable functional prognosis (75.6% versus 34.5%; p < 0.001) upon discharge compared to the no ABS cohort, along with higher proportion of intraoperative malignant brain bulge (43.8% versus 0%; p < 0.001).

Conclusion: The incidence of ABS associated with ASDH is significantly high overall. Patients with ASDH who have young age, low PWR, and traumatic SAH are at an increased risk of developing post-traumatic ABS, and therefore of poor clinical outcomes.

Keywords: acute brain swelling; acute subdural hematoma; intraoperative brain bulge; outcome; risk factors; traumatic brain injury.