Background: Traumatic subarachnoid hemorrhage (SAH) is one of the most common forms of head trauma seen in the emergency room yet in isolation rarely requires operative intervention. Often, the presence of a larger secondary hemorrhagic lesion is what leads to neurosurgery and expedited management.
Purpose: We set out to find which factors lead to neurosurgical operations in isolated traumatic subarachnoid hemorrhage.
Methods: Data was collected from a Level I trauma registry, from years 2009-2010. All patients with intracranial head injury initially managed in the ER were identified. Using ICD-9 codes, patients were subdivided identifying those with hemorrhagic secondary lesions (ie., subdural hematoma, epidural hematoma, intracranial bleed) versus those with isolated traumatic SAH. We then noted how many follow up CT scans each patient had and which patients underwent major neurosurgical interventions excluding intracranial pressure monitoring. Demographic data, as well as other trauma markers were captured to identify predictors that led to a major neurosurgical intervention.
Results: The trauma registry database yielded 2133 patients that presented with intracranial injury in the years of 2009-2010. Of these, 256 (12%) had SAH plus another intracranial insult and 111 (5%) had an isolated SAH. Upon further review of the combined 367 patients evaluated in the emergency room with a diagnosis of traumatic SAH, 3 patients with isolated traumatic SAH required minor neurosurgical intervention (i.e. invasive ICP monitoring). Of the secondary lesions that prompted surgical intervention subdural hematoma (65%) was most common followed by other types of intracranial bleeds (29%), epidural hematoma (9.5%), etc. Based on our results, isolated traumatic SAH patients with a GCS ? 4 did not require surgery initially and also at an average of 27 months of follow up. These patients received an average of 5.5 CT scans in the hospital and as an outpatient.
Conclusion: The results of this study are of value to the initial evaluation, triage, and management of the head injured patient particularly to non-neurosurgical health care personnel in the emergency room .