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Prevalence and Prognosis of Traumatic Intraventricular Hemorrhage in Patients with Blunt Head Trauma

Atzema, Clare MD; Mower, William R. MD, PhD; Hoffman, Jerome R. MA, MD; Holmes, James F. MD; Killian, Anthony J. RN; Wolfson, Allan B. MD; For the National Emergency X-Radiography Utilization Study (NEXUS) II Group

Journal of Trauma-Injury Infection & Critical Care: May 2006 - Volume 60 - Issue 5 - pp 1010-1017
doi: 10.1097/01.ta.0000218038.28064.9d
Original Articles

Background: Most studies of traumatic intraventricular hemorrhage (tIVH) contain fewer than 25 subjects and are retrospective in design, providing minimal information about the entity and its clinical significance.

Methods: We prospectively enrolled trauma patients from 18 centers in North America in the National Emergency X-Radiography Utilization Study (NEXUS) II if they received an emergent head computed tomography (CT) scan, as determined by the managing physician. Clinical data were collected at the time of enrollment and CT reports were compiled at least 1 month later. We calculated prevalence and demographics of tIVH from the 18 sites, while outcome data were gathered from medical records of patients with tIVH who were seen at any of six sites that participated in the follow-up portion of the study. We considered patients who underwent a neurosurgical intervention or who had a “poor outcome” (Glasgow Outcome Scale score of 1 to 3, death, persistent vegetative state, or severe disability) to have suffered a “combined outcome.”

Results: Prevalence of tIVH among all trauma patients who received a head CT was 118 in 8,374, or 1.41%. Among tIVH patients, 70% had a “poor outcome” and 76% had a “combined outcome.” A poor outcome appeared to be associated with an abnormal presenting Glasgow Coma Scale score and involvement of the third or fourth ventricle, whereas age appeared to be unrelated. Patients with tIVH and no major associated injury on CT tended to do well; only one patient with isolated tIVH had a poor outcome.

Conclusions: Traumatic IVH is rare and is associated with poor outcomes that seem to be the consequence of associated injuries. Isolated tIVH patients who are clinically well appear to have a functional outcome; we were unable to identify a case of isolated tIVH, combined with a normal neurologic examination, resulting in a poor or combined outcome.

From the Emergency Medicine Center (C.A., W.R.M., J.R.H.), David Geffen School of Medicine at UCLA, Los Angeles, California; Division of Emergency Medicine (J.F.H.), University of California, Davis School of Medicine, Sacramento, California; Cooper University Hospital (A.J.K.), Camden, New Jersey; and the Department of Emergency Medicine (A.B.W.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Submitted for publication March 13, 2004.

Accepted for publication January 19, 2006.

This work is funded in part by Grant RO1 HS09699 from the Agency for Healthcare Research and Quality.

Address for reprints: William R. Mower, MD, PhD, UCLA Emergency Medicine Center, 924 Westwood Blvd., Suite 300, Los Angeles, CA 90024; email: nexusgrp@ucla.edu.

© 2006 Lippincott Williams & Wilkins, Inc.