Concurrent Types of Intracranial Hemorrhage are Associated with a Higher Mortality Rate in Adult Patients with Traumatic Subarachnoid Hemorrhage: A Cross-Sectional Retrospective Study

Rau, Cheng-Shyuan; Wu, Shao-Chun; Hsu, Shiun-Yuan; Liu, Hang-Tsung; Huang, Chun-Ying; Hsieh, Ting-Min; Chou, Sheng-En; Su, Wei-Ti; Liu, Yueh-Wei; Hsieh, Ching-Hua

doi:10.3390/ijerph16234787

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Concurrent Types of Intracranial Hemorrhage are Associated with a Higher Mortality Rate in Adult Patients with Traumatic Subarachnoid Hemorrhage: A Cross-Sectional Retrospective Study

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Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan

Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan

Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan

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Department of General Gurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan

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Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan

Authors to whom correspondence should be addressed.

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These authors contributed equally to this paper.

Int. J. Environ. Res. Public Health 2019, 16(23), 4787; https://doi.org/10.3390/ijerph16234787

Received: 31 October 2019 / Revised: 25 November 2019 / Accepted: 26 November 2019 / Published: 29 November 2019

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Abstract

Traumatic subarachnoid hemorrhage (SAH) is the second most frequent intracranial hemorrhage and a common radiologic finding in computed tomography. This study aimed to estimate the risk of mortality in adult trauma patients with traumatic SAH concurrent with other types of intracranial hemorrhage, such as subdural hematoma (SDH), epidural hematoma (EDH), and intracerebral hemorrhage (ICH), compared to the risk in patients with isolated traumatic SAH. We searched our hospital’s trauma database from 1 January, 2009 to 31 December, 2018 to identify hospitalized adult patients ≥20 years old who presented with a trauma abbreviated injury scale (AIS) of ≥3 in the head region. Polytrauma patients with an AIS of ≥3 in any other region of the body were excluded. A total of 1856 patients who had SAH were allocated into four exclusive groups: (Group I) isolated traumatic SAH, n = 788; (Group II) SAH and one diagnosis, n = 509; (Group III) SAH and two diagnoses, n = 493; and (Group IV) SAH and three diagnoses, n = 66. One, two, and three diagnoses indicated occurrences of one, two, or three other types of intracranial hemorrhage (SDH, EDH, or ICH). The adjusted odds ratio with a 95% confidence interval (CI) of the level of mortality was calculated with logistic regression, controlling for sex, age, and pre-existing comorbidities. Patients with isolated traumatic SAH had a lower rate of mortality (1.8%) compared to the other three groups (Group II: 7.9%, Group III: 12.4%, and Group IV: 27.3%, all p < 0.001). When controlling for sex, age, and pre-existing comorbidities, we found that Group II, Group III, and Group IV patients had a 4.0 (95% CI 2.4–6.5), 8.9 (95% CI 4.8–16.5), and 21.1 (95% CI 9.4–47.7) times higher adjusted odds ratio for mortality, respectively, than the patients with isolated traumatic SAH. In this study, we demonstrated that compared to patients with isolated traumatic SAH, traumatic SAH patients with concurrent types of intracranial hemorrhage have a higher adjusted odds ratio for mortality. View Full-Text

Keywords: traumatic brain injury; subarachnoid hemorrhage (SAH); subdural hematoma (SDH); epidural hematoma (EDH); intracerebral hemorrhage (ICH); mortality

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Rau, C.-S.; Wu, S.-C.; Hsu, S.-Y.; Liu, H.-T.; Huang, C.-Y.; Hsieh, T.-M.; Chou, S.-E.; Su, W.-T.; Liu, Y.-W.; Hsieh, C.-H. Concurrent Types of Intracranial Hemorrhage are Associated with a Higher Mortality Rate in Adult Patients with Traumatic Subarachnoid Hemorrhage: A Cross-Sectional Retrospective Study. Int. J. Environ. Res. Public Health 2019, 16, 4787. https://doi.org/10.3390/ijerph16234787

AMA Style

Rau C-S, Wu S-C, Hsu S-Y, Liu H-T, Huang C-Y, Hsieh T-M, Chou S-E, Su W-T, Liu Y-W, Hsieh C-H. Concurrent Types of Intracranial Hemorrhage are Associated with a Higher Mortality Rate in Adult Patients with Traumatic Subarachnoid Hemorrhage: A Cross-Sectional Retrospective Study. International Journal of Environmental Research and Public Health. 2019; 16(23):4787. https://doi.org/10.3390/ijerph16234787

Chicago/Turabian Style

Rau, Cheng-Shyuan, Shao-Chun Wu, Shiun-Yuan Hsu, Hang-Tsung Liu, Chun-Ying Huang, Ting-Min Hsieh, Sheng-En Chou, Wei-Ti Su, Yueh-Wei Liu, and Ching-Hua Hsieh. 2019. "Concurrent Types of Intracranial Hemorrhage are Associated with a Higher Mortality Rate in Adult Patients with Traumatic Subarachnoid Hemorrhage: A Cross-Sectional Retrospective Study" International Journal of Environmental Research and Public Health 16, no. 23: 4787. https://doi.org/10.3390/ijerph16234787

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Concurrent Types of Intracranial Hemorrhage are Associated with a Higher Mortality Rate in Adult Patients with Traumatic Subarachnoid Hemorrhage: A Cross-Sectional Retrospective Study

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