Early Progression of Traumatic Cerebral Contusions: Characterization and Risk Factors

Background: Traumatic intracerebral contusions carry a high rate of early progression and are associated with morbidity and mortality. Our objectives were to better characterize the prevalence of progression of traumatic contusions, risk factors, and the association with outcome.

Methods: Participants were 46 patients with traumatic intracerebral contusion who underwent a repeat computed tomography (CT) scan within 24 hours of injury. Hemorrhage volume on the CT scan was quantified using the ABC/2 technique. Univarite and multivariate statistics were used to define growth (percentage increase and absolute volume increase), to examine the relationship between the risk factors of interest and hemorrhage expansion, and with neurologic function and discharge destination.

Results: Sixty-five percent of the patients experienced progression in the size of the lesion in the initial 24 hours postinjury. The international normalized ratio was significantly higher in the group that demonstrated progression. Deterioration on the Glasgow Coma Score was associated with a threefold risk of hemorrhage expansion being found on the CT as defined by percentage increase (odds ratio [OR] = 3.43; 95% confidence interval [CI]: 0.90 to 13.10) and similarly when defined as absolute increase in volume (OR = 3.32; 95% CI: 0.96 to 11.41). Controlling for injury severity, there was an association between hemorrhage growth and death with those displaying progression more likely to die during hospitalization (OR = 1.08; 95% CI: 0.97 to 1.20).

Conclusion: A high proportion of intracerebral contusions evolve in size very early in the postinjury period and are associated with negative outcomes. There is still not a proven therapy for limiting the expansion although the association of an elevated international normalized ratio with expansion suggests that coagulation abnormalities must be actively corrected.