We reviewed all cases of adults TBI treated at Shanghai Sixth People’s Hospital, People’s Republic of China during a 2-year period (January 2016 to December 2018) using the hospital’s electronic medical record system. Similar to our previous inclusion criteria [4 (link)], patients who were diagnosed as isolated TBI with at least 2 CT scans were included. We excluded (1) patients underwent surgical intervention after the first CT scan, although the follow up CT after surgery was available; (2) patients with known coagulation disorders; and (3) patients with intracranial pathological changes before their injury. Accordingly, of the initial 576 consecutive TBI patients, 419 patients remained for subsequent analysis.
Demographic and clinical variables were collected as follows: age, gender, mechanism of injury, Glasgow Coma Scale (GCS) score, motor GCS score, pupil reactivity, time to the first computed tomography (CT) scan, skull fracture, primary lesion volume, EDH, tSAH, intraventricular hemorrhage (IVH), midline shift, cistern compression, D-dimer, length of hospital stay (LOS), posttraumatic cerebral hydrocephalus, posttraumatic cerebral infarction, and surgical interventions including hematoma evacuation and decompressive craniectomy (DC).
All enrolled patients were dichotomized into PHI (those IPCH, EDH, SDH, and tSAH that progress) and non-PHI groups (those IPCH, EDH, SDH, and tSAH that did not progress). Within the PHI group, patients were further divided into progressive IPCH, EDH, SDH, and tSAH subgroups. For patients with TBI exhibit mixed picture of hemorrhage, the pathoanatomic type of PHI was recorded as the major proportion of hematoma/contusion. Because the events of pSDH and ptSAH were infrequent, only patients with IPCH or EDH were selected for subgroup propensity score matching (PSM) [11 (link)].
Neurological outcome was recorded using the 6-month score on the Glasgow Outcome Scale (GOS). The 6-month GOS was split into dead (score = 1), unfavorable survival (2 or 3), and favorable survival (4 or 5). All data were collected by regular outpatient follow-up or telephone interview.
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