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Identification of Demographic and Clinical Prognostic Factors in Traumatic Intraventricular Hemorrhage

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Abstract

Background

The presence of traumatic intraventricular hemorrhage (tIVH) following traumatic brain injury (TBI) is associated with worse neurological outcome. The mechanisms by which patients with tIVH have worse outcome are not fully understood and research is ongoing, but foundational studies that explore prognostic factors within tIVH populations are also lacking. This study aimed to further identify and characterize demographic and clinical variables within a subset of patients with TBI and tIVH that may be implicated in tIVH outcome.

Methods

In this observational study, we reviewed a large prospective TBI database to determine variables present on admission that predicted neurological outcome 6 months after injury. A review of 7,129 patients revealed 211 patients with tIVH on admission and 6-month outcome data. Hypothesized risk factors were tested in univariate analyses with significant variables (p < 0.05) included in logistic and linear regression models. Following the addition of either the Rotterdam computed tomography or Glasgow Coma Scale (GCS) score, we employed a backward selection process to determine significant variables in each multivariate model.

Results

Our study found that that hypotension (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.13–0.94, p = 0.04) and the hemoglobin level (OR = 1.33, 95% CI = 1.09–1.63, p = 0.006) were significant predictors in the Rotterdam model, whereas only the hemoglobin level (OR = 1.29, 95% CI = 1.06–1.56, p = 0.01) was a significant predictor in the GCS model.

Conclusions

This study represents one of the largest investigations into prognostic factors for patients with tIVH and demonstrates that admission hemoglobin level and hypotension are associated with outcomes in this patient population. These findings add value to established prognostic scales, could inform future predictive modeling studies, and may provide potential direction in early medical management of patients with tIVH.

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Funding

This work was supported by capstone project funding from the Frank H. Netter M.D. School of Medicine at Quinnipiac University.

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Authors and Affiliations

  1. Frank H. Netter M.D. School of Medicine, Quinnipiac University, 830 Orange Street, New Haven, CT, 06511, USA

    Abby K. Scurfield

  2. Division of Biostatistics, Department of Public Health Sciences, Davis Clinical and Translational Science Center, University of California, 2921 Stockton Blvd., Suite 1400, Sacramento, CA, 95817, USA

    Machelle D. Wilson

  3. Department of Neurological Surgery, University of California, 4860 Y Street, Suite 3740,, 95817, Davis, Sacramento, CA, USA

    Gene Gurkoff, Ryan Martin & Kiarash Shahlaie

  4. Department of Neurology, University of California, 4860 Y Street, Suite 3740,, Davis, Sacramento, CA, USA

    Ryan Martin

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Contributions

AKScurfield: conceptualization, investigation, original draft preparation, visualization, funding acquisition. MDW: methodology, formal analysis, review and editing. GG: conceptualization, review and editing, supervision. RM: writing, review and editing. KS: conceptualization, data analysis/interpretation, writing, review and editing, supervision, project administration.

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Correspondence to Kiarash Shahlaie.

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Scurfield, A.K., Wilson, M.D., Gurkoff, G. et al. Identification of Demographic and Clinical Prognostic Factors in Traumatic Intraventricular Hemorrhage. Neurocrit Care 38, 149–157 (2023). https://doi.org/10.1007/s12028-022-01587-z

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