Delayed Neurologic Deterioration Following Mild Head Injury: Etiology, Temporal Course and Outcomes

Keywords: outcome, cognition, traumatic brain injury, head injury, memory

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     Mild head injury (MHI) complicated by an intracranial hemorrhage (ICH) is a common cause of hospital admission following head trauma. Most patients are treated non-operatively, remain neurologically stable, and are discharged following a short hospital stay. However, a small percentage of patients suffer delayed neurologic deterioration (DND).
     The objective of this study is to identify the etiology, temporal course, and outcomes of patients who deteriorated after presenting with MHI.
     We performed a retrospective review on all adult patients (age = 18) with MHI (GCS = 13) and ICH who presented to a Level 1 trauma center over 53 consecutive months. Patients who suffered from a DND (GCS drop = 2) were identified.
     Relevant data was collected to determine the incidence, timings, cause and outcome of delayed neurologic deterioration.
     Of the 757 patients MHI patients admitted for observation, 31 (4.1%) suffered from a delayed neurologic deterioration. Ninety-four percent of patients deteriorated within the first 24 hours from arrival. Average hospital length of stay (LOS) was 10.5 days. Twenty one patients 67%) deteriorated due to progressive intracranial hemorrhage (PIH) and 10 patients deteriorated due to non-PIH causes. Seven patients (22%) died. Variables significantly associated (p < 0.05) with mortality included age < 65, deteriorating due to PIH, and shorter interval from arrival to deterioration
     This is a retrospective study.
     Delayed neurologic deterioration following MHI with ICH occurred in less than 5% of patients and typically within 24 hours after admission. It resulted in significant morbidity and mortality.
     Further research of DND following MHI needs to be done.


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