The Correlative Risk Factors Analysis And Clinical Monitoring Of Progressive Traumatic Intracerebral Hematoma

Background and Objective: As a type of progressive hemorrhagic injury after head injury, progressive traumatic intracerebral hematoma (PTICH) has been payed close attentions more and more by clinical neurosurgeons. Distinguished from DTICH, PTICH is used to describe the hematomas which have formed after head injury through CT scan, but it' s volume increased after a period of time. PTICH is very common as well as DTICH in clinical work, but only few studies are available on risk factors of PTICH. This type of hematomas formed earlier than DTICH and usually adopted espectant treatment on admission, most of which need to accept operation once expanding. The clinical symptom and the change of nervous system sign are not manifest in some of patients when PTICH formed. If diagnosis was not established in first time, PTICH would induce to disfuctions of nervous system permanently and result in harmful effects on prognosis of patients. So, it is very important to improve the patients by analyzing the correlated risk factors, clinical monitoring after admission, early diagnosis and correct treatment. A prospective study was aimed to find out risk factors associated with such traumatic lesions.Materials and Methods: Present study is based on analyzing 73 cases of intracerebral hematomas retrospectively which accepted espectant treatment because of little hematomas and light mess effects. 27(36. 9%) hematomas of which expanded in size. Computerized tomography (CT) scan was done in all the patients at the time of admission and within 24 hours of injury. Dynamic CT scans were done to observe the changes of intracerebral hematoma according to vital signs, GCS score and the clinical monitoring of symptoms and signs of nervous system of patients. The volume and location intracerebral hematoma, combining other type of hematoma or not ,midline shift if any, prothrombin time, activated partial thromboplastin time, bleeding time, clotting time and platelet counts, Glasgow coma scale at admission and discharge and Glasgow outcome score at 6 months follow up were recorded.Results: Seventy five percent, 52.9 and 20.4% patients developed PTICH in Glasgow Coma scale (GCS) of 8 and below, 9-12 and 13-15 respectively. The chances of forming PTICH were higher in patients with other associated hematomas (43. 6%) as compared to isolated hematoma (16. 7%) (Fisher' s exact results P =0. 032). Most cases of PTICH had some degree of midline shift when first CT scans were done and considerably higher proportion had presence of disturbances of blood coagulation. The results of logistic regression analysis showed GCS, midline shift and disturbances of blood coagulation as significant predictors for the expanding hematoma. All of PTICH developed within 12 hours of injury.Conclusions: PTICH is quite common and majority of them formed early after the injury. These lesions were common in patients with poor GCS, associated hematomas, associated disturbances of blood coagulation and midline shift.