Traumatic subarachnoid haemorrhage in the ICU

Objective

A retrospective observational study to establish the traumatic subarachnoid haemorrhage (tSAH) ratio in all traumatic brain injury (TBI), the overall prognosis, and to determine whether the quantity and distribution of blood in subarachnoid space influences prognosis.

Materials and methods

Over a period of 1.5 years, 98 patients were admitted diagnosed with TBI. Fifty-two (53.06%) had tSAH. The Greene classification was used to determine the degree of bleeding. We differentiated between patients with tSAH diffused in the convexity, in basal cisterns and those with bleeding in both (mixed pattern). We recorded the sex, age, Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) at the time of discharge from acute hospitalisation. For the statistical analysis three groups of TBI were considered, according to the GCS: slight (GCS 13–15), moderate (GCS 3–7) and severe (GCS 3–7). Analysis was carried out to determine whether there were any positive or negative factors related to tSAH (paying particular attention to blood distribution). The relationship between age, Greene classification, GCS and GOS were evaluated by multiple logistic regression and chi-square test.

Results

The prognosis of the patients with tSAH was worse (Table 1). Chi-square = 5.21 P = 0.022. The follow-up study was carried out until discharge from acute hospitalisation: 21 patients (40.38%) had a good prognosis and 30 (57.69%) had an unfavourable prognosis. The overall mortality was 21 (46.15%). There is no statistically significant relationship between tSAH distribution and the GCS on admission, but there is relationship between tSAH distribution and the GOS. A logistic regression model to evaluate the contribution of the GCS, degree of Greene classification and age with the GOS shows these results (Table 2).

Table 1 (abstract P449)

Table 2 (abstract P449)

Conclusion

TSAH is a negative prognosis factor: the degree of tSAH is significantly related to the clinical condition on admission and the prognosis of the patient. The presence of tSAH in the cisterns and convexity (mixed pattern) indicates a worse prognosis. It is most frequently located in the convexity and basal cisterns.