ABSTRACT
Objective To investigate the high-risk factors of progressive hemorrhagic injury (PHI)after acute traumatic brain injury(TBI)and discuss its time for first scheduled brain CT.Methods Retrospective analysis of clinical data of 329 adult patients with blunt TBI,admitted to second affiliated hospital of Suzhou University from August 2009 to July 2010,was performed.Patients were divided into PHI high-risk group and non-PHI high-risk group based on whether clinical symptoms worsened before the first routine scheduled brain CT;and control study was established. Results Forty-one patients from the PHI high-risk group were performed first routine scheduled brain CT ahead of time([3.67±0.96]h)for appearing worsened clinical symptoms,while 288 patients with non-PHI high-risk group were performed first routine brain CT as schedule(8.38±3.03 h);significant difference on the time for the first brain CT was noted between the 2 groups(P<0.05).Statistical differences in aspects of intracranial hematoma volume>10 mL,intracranial hematoma type≥2,associated subarachnoid hemorrhage on initial brain CT,disturbance of consciousness,pupil dilation and scores of Glasgow Coma Scale≤12 on admission were noted between the 2 groups(P<0.05),and statistical differences in aspects of reduced platelet(Plt),prolonged prothrombin time(PT),prolonged activated partial thromboplastin time(APTT),decreased Fibrinogen(FIB)on admission,bilateral brain injury,associated brain contusion,and skull fracture with epidural hematoma on initial brain CT were found between the 2 groups(P<0.05).Logistic regression analysis showed that intracranial hematoma volume>10 mL on initial brain CT, disturbance of consciousness and pupil dilation on admission were predictors for PHI high-risk patients (P<0.05). Conclusion For patients with intracranial hematoma volume>10 mL on initial brain CT, disturbance of consciousness and pupil dilation on admission within 2 h of TBI, first routine scheduled brain CT should be performed within 3-4 h of TBI or even earlier.