Posttraumatic Contusion: Clinical and Radiologic Factors for Progression in Early Postinjury Period

Objective To identify clinical and radiological factors to predict progression of contusion and its impact on clinical deterioration of neurological status, which will ultimately help deciding surgical intervention in initially conservatively managed patients. Methods This is a prospective, observational study containing a total of 110 patients who had contusions after traumatic brain injury with size of >= 2 mL by computed tomographic (CT) scan, managed conservatively in initial period, and had at least two subsequent CT scans within 72 hours after injury. Significant radiological progression was defined as > 30% increase in volume from baseline in CT scan. Results The progression of contusion was significantly associated with age, sex, contusion volume in initial CT, effacement of cistern, subdural hematoma (SDH), subarachnoid hemorrhage(SAH), and coagulopathy. SDH and SAH (p<0.05) were found to be as independent risk factors for contusion progression. The need for surgery after initial conservative management was required in 11.81% cases, and the deterioration of Glasgow coma scale (GCS) volume in the second CT were found to be significant independent predictors for the surgical intervention (p<0.05). Conclusions About half of the patients presenting with TBI managed conservatively in initial period show significant progression of contusion mostly within 24 hours after injury. Patients with SAH, SDH and deranged coagulation profile are particularly at high risk for progression of contusion.