RETROSPECTIVE OBSERVATIONAL STUDY OF 448 CEREBRAL CONTUSIONS IN A TERTIARY CARE TRAUMA CENTRE: ANALYSIS OF THEIR CLINICAL & RADIOLOGICAL PROGRESSION AND OUTCOME

Abstract

Introduction: Traumatic cerebral contusion is one of the leading cause of morbidity and mortality in Neurosurgery. Patients can be either treated conservatively or surgically. Many patients who are treated conservatively may have CT scan progression and need surgery secondarily. This retrospective study was designed to study the clinical presentation and interventions predicting CT progression of hematoma and final outcome. Material and Methods: The study was conducted from April 2017 to December 2019 on all the patients of traumatic cerebral contusions, diagnosed by CT scan. Patients received either conservative treatment initially or underwent upfront surgery, and had at least one other CT scan during the acute hospitalization. Patients clinical history, CT progression and any intervention were noted. The patient’s disposition status was classified as discharged home, or to another institution, or whether the patient died. Results: Among the total 448 patients, 78.5% patients required surgery at presentation. 53.3% had a CT progression after repeat CT scan, among them 109 (48.8%) were operated. CT progression was seen more frequently in patients with coagulation abnormalities. Among patients with history of antiplatelet medication receiving platelet therapy, only 31% patients had CT progression. Patients who has poor initial GCS (Glasgow coma scale), underwent tracheostomy and had secondarily operated due to CT progression were discharged late. Conclusion: Coagulation defects was an important risk factor for CT progression. Platelet replacement therapy significantly decreased surgical intervention in patients with antiplatelet therapy. Poor initial GCS, secondary surgery and tracheostomy lengthened the hospital stay.