Clinical significance of posttraumatic intracranial hemorrhage in clinically mild brain injury: a retrospective cohort study.

Justin Z Wang, Christopher D Witiw, Nadia Scantlebury, Noah Ditkofsky, Avery B Nathens, Leodante da Costa

Open access · diamondAbstract read

In one paragraph

Article in CMAJ open. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it

0cells of the map it votes in

0citing papers in PubMed

0.6field-weighted citation impact, top 30% of its field

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed, 5 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Justin Z WangDivision of Neurosurgery (Wang, Witiw, da Costa), Department of Surgery, University of Toronto; Division of Neurosurgery (Scantlebury, da Costa), Department of Surgery, and Department of Medical Imaging (Ditkofsky), Sunnybrook Health Sciences Centre, University of Toronto; Department of Surgery (Nathens, da Costa), University of Toronto, Toronto, Ont.

Christopher D WitiwDivision of Neurosurgery (Wang, Witiw, da Costa), Department of Surgery, University of Toronto; Division of Neurosurgery (Scantlebury, da Costa), Department of Surgery, and Department of Medical Imaging (Ditkofsky), Sunnybrook Health Sciences Centre, University of Toronto; Department of Surgery (Nathens, da Costa), University of Toronto, Toronto, Ont.

Nadia ScantleburyDivision of Neurosurgery (Wang, Witiw, da Costa), Department of Surgery, University of Toronto; Division of Neurosurgery (Scantlebury, da Costa), Department of Surgery, and Department of Medical Imaging (Ditkofsky), Sunnybrook Health Sciences Centre, University of Toronto; Department of Surgery (Nathens, da Costa), University of Toronto, Toronto, Ont.

Noah DitkofskyDivision of Neurosurgery (Wang, Witiw, da Costa), Department of Surgery, University of Toronto; Division of Neurosurgery (Scantlebury, da Costa), Department of Surgery, and Department of Medical Imaging (Ditkofsky), Sunnybrook Health Sciences Centre, University of Toronto; Department of Surgery (Nathens, da Costa), University of Toronto, Toronto, Ont.

Avery B NathensDivision of Neurosurgery (Wang, Witiw, da Costa), Department of Surgery, University of Toronto; Division of Neurosurgery (Scantlebury, da Costa), Department of Surgery, and Department of Medical Imaging (Ditkofsky), Sunnybrook Health Sciences Centre, University of Toronto; Department of Surgery (Nathens, da Costa), University of Toronto, Toronto, Ont.

Leodante da CostaDivision of Neurosurgery (Wang, Witiw, da Costa), Department of Surgery, University of Toronto; Division of Neurosurgery (Scantlebury, da Costa), Department of Surgery, and Department of Medical Imaging (Ditkofsky), Sunnybrook Health Sciences Centre, University of Toronto; Department of Surgery (Nathens, da Costa), University of Toronto, Toronto, Ont. leo.dacosta@sunnybrook.ca.

Sunnybrook Health Science Centre · CAHealth Sciences Centre · CAUniversity of Toronto · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMuch attention has been focused on management of severe traumatic brain injury (TBI); however, comparatively little is known about management of traumatic hemorrhage in clinically mild TBI. We aimed to clarify the role of clinical observation and repeat radiography for patients with mild TBI and abnormal findings on initial computed tomography (CT) of the head.

methodsWe queried the neurotrauma database of the Ontario Trauma Registry and the Sunnybrook institutional database to identify patients with CT findings of a traumatic hemorrhage or calvarial fracture between November 2014 and December 2016. Exclusionary criteria were age less than 16 years, Glasgow Coma Scale (GCS) score less than 13, anticoagulant use, bleeding diathesis and midline shift greater than 5 mm. The primary outcome was the need for neurosurgical intervention.

resultsA total of 607 patients were included. Most (374 [61.6%]) had a GCS score of 15; 185 (30.5%) and 48 (7.9%) had a GCS score of 14 and 13, respectively. Five patients (0.8%) required surgical intervention, all within the first 72 hours, owing to clinical deterioration with subsequently demonstrated radiographic evidence of expanding hemorrhage. Most patients (506 [83.4%]) had routine repeat imaging, without documented change in their neurologic status.

interpretationThe majority of patients in our cohort had repeat imaging, which did not influence surgical management, at substantial cost to the health care system. The findings suggest the need to reevaluate repeat imaging protocols for this subset of patients with TBI.

Identifiers

PMID31431483

DOI10.9778/cmajo.20180188

PMCPMC6703987

OpenAlexW2969729677

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.