Abstract：
Traumatic subarachnoid hemorrhage (tSAH) is a common consequence of head trauma. Treatment of patients with tSAH commonly involves serial computed tomography (CT) scans to assess for expansile hemorrhage. However, growing evidence suggests that these patients rarely deteriorate or require neurosurgical intervention. We assessed the utility of repeat CT scans in adult patients with isolated tSAH and an intact initial neurological examination.
Patients presenting to Mass General Brigham hospitals with tSAH between 2000 and 2021 were eligible for inclusion in this retrospective cohort study. Patients were excluded if subarachnoid hemorrhage was nontraumatic, they experienced another form of intracerebral hemorrhage, or they had a documented Glasgow Coma Scale score of ≤12 and/or poor presenting neurological examination. Univariate and multivariate regression models were used for statistical analysis.
Overall, 405 patients were included (191 male). The most common mechanism of trauma was fall from standing (58%). The mean number of total CT scans for all patients was 2.3, with 329 patients (80%) receiving ≥2 scans. In 309 patients, no significant neurological symptoms were present. No patients developed acute neurological deterioration or required neurosurgical intervention related to their bleed, although 5 patients had mild hemorrhagic expansion on follow-up imaging.
In this study, repeat imaging rarely demonstrated meaningful hemorrhagic expansion in this cohort of neurologically intact patients with isolated tSAH. In these patients with mild traumatic brain injury, excessive CT scans are perhaps unlikely to affect patient management and may present unnecessary burden to patients and hospital systems.
Patients presenting to Mass General Brigham hospitals with tSAH between 2000 and 2021 were eligible for inclusion in this retrospective cohort study. Patients were excluded if subarachnoid hemorrhage was nontraumatic, they experienced another form of intracerebral hemorrhage, or they had a documented Glasgow Coma Scale score of ≤12 and/or poor presenting neurological examination. Univariate and multivariate regression models were used for statistical analysis.
Overall, 405 patients were included (191 male). The most common mechanism of trauma was fall from standing (58%). The mean number of total CT scans for all patients was 2.3, with 329 patients (80%) receiving ≥2 scans. In 309 patients, no significant neurological symptoms were present. No patients developed acute neurological deterioration or required neurosurgical intervention related to their bleed, although 5 patients had mild hemorrhagic expansion on follow-up imaging.
In this study, repeat imaging rarely demonstrated meaningful hemorrhagic expansion in this cohort of neurologically intact patients with isolated tSAH. In these patients with mild traumatic brain injury, excessive CT scans are perhaps unlikely to affect patient management and may present unnecessary burden to patients and hospital systems.
摘要：
背景：创伤性蛛网膜下腔出血（tSAH）是头部创伤的常见后果。tSAH患者的治疗通常涉及连续计算机断层扫描（CT）扫描以评估膨胀性出血。然而,越来越多的证据表明，这些患者很少恶化或需要神经外科干预。我们评估了在孤立的tSAH和完整的初始神经系统检查的成年患者中重复CT扫描的实用性。
方法：在2000年至2021年间向MassGeneralBrigham医院就诊的tSAH患者符合纳入本回顾性队列研究的条件。如果蛛网膜下腔出血是非创伤性的，则排除患者。他们经历了另一种形式的脑出血，或者他们有记录的格拉斯哥昏迷评分≤12分和/或表现较差的神经系统检查。使用单变量和多变量回归模型进行统计分析。
结果：总体而言，纳入405例患者（男性191例）。最常见的创伤机制是站立跌倒（58％）。所有患者的平均CT扫描总数为2.3，其中329名患者（80％）接受了≥2次扫描。在309名患者中，未出现明显的神经症状。没有患者出现急性神经功能恶化或需要与出血相关的神经外科干预，尽管5例患者在随访影像学上有轻度出血性扩张。
结论：在这项研究中，在这一神经完整的孤立性tSAH患者队列中,重复成像很少显示有意义的出血性扩张.在这些轻度创伤性脑损伤的患者中，过度的CT扫描可能不太可能影响患者管理,并可能给患者和医院系统带来不必要的负担.
方法：在2000年至2021年间向MassGeneralBrigham医院就诊的tSAH患者符合纳入本回顾性队列研究的条件。如果蛛网膜下腔出血是非创伤性的，则排除患者。他们经历了另一种形式的脑出血，或者他们有记录的格拉斯哥昏迷评分≤12分和/或表现较差的神经系统检查。使用单变量和多变量回归模型进行统计分析。
结果：总体而言，纳入405例患者（男性191例）。最常见的创伤机制是站立跌倒（58％）。所有患者的平均CT扫描总数为2.3，其中329名患者（80％）接受了≥2次扫描。在309名患者中，未出现明显的神经症状。没有患者出现急性神经功能恶化或需要与出血相关的神经外科干预，尽管5例患者在随访影像学上有轻度出血性扩张。
结论：在这项研究中，在这一神经完整的孤立性tSAH患者队列中,重复成像很少显示有意义的出血性扩张.在这些轻度创伤性脑损伤的患者中，过度的CT扫描可能不太可能影响患者管理,并可能给患者和医院系统带来不必要的负担.
