Delayed traumatic intracranial haemorrhage and progressive traumatic brain injury in a major referral centre based in a developing country

A repeat Computer Tomographic (CT) brain after 24 -48 hours from the 1st scanning is usually practiced in most hospitals in South East Asia where intracranial pressure monitoring (ICP) is routinely not done. This interval for repeat CT would be shortened if there was a deterioration in Glasgow Coma Scale (GCS) most of the time the prognosis of any intervention may be too late especially in hospitals with high patient to doctor ratio causing high mortality and morbidity. The purpose of this study was to determine the important predictors for early detection of Delayed Traumatic Intracranial Haemorrhage (DTICH) and Progressive Traumatic Brain Injury (PTBI) before deterioration of GCS occurred as well as the most ideal timing of repeated CT brain for patients admitted in Malaysian hospitals. A total of 81 patients were included in this study over a period of six months. The CT scan brain were studied by comparing the first and second CT brain to diagnose the presence of DTICH/PTBI. The predictors tested were categorized into patient factors, CT brain findings and laboratory investigations.The mean age was 33.1 ± 15.7 years with a male preponderance of 6.36:1. Among them, (81.5%) of them were patients from road traffic accidents with Glasgow Coma Scale ranging from 4 – 15 (median of 12) upon admission. The mean time interval delay between trauma and first CT brain was 179.8 ± 121.3 minutes for the PTBI group. The DTICH group, (9.9%) of the patients were found to have new intracranial clots. Significant predictors detected were different referral hospitals (p=0.02), total GCS status (p=0.026), motor component of GCS (p=0.043), haemoglobin level (p