Predictive Models In Traumatic Brain Injury

Predictive Models in Traumatic Brain Injury

Progression of intracranial hemorrhage (PICH) after TBI is common and highly morbid.  

Progressive intracranial hemorrhage (PICH) represents a significant cause of secondary brain injury in traumatic brain injury (TBI), linked to prolonged ICU admissions, poorer neurological outcomes, and increased mortality rates. PICH is typically defined by a hemorrhage expansion of 30% or more, or the emergence of new hemorrhages within the intra- and extra-axial intracranial compartments between the initial and subsequent head computed tomography (CT) scans.

This condition generally manifests within the first 36 hours post-injury, particularly during the 'hyperacute' initial 6 hours, which justifies the standard 6-hour follow-up CT protocol. Approximately 33%-50% of patients exhibiting hemorrhage on the initial CT ('CT-positive') develop PICH.

Despite being a modifiable secondary brain injury in moderate to severe TBI cases, clinicians lack real-time risk indicators for PICH, relying instead on “after the fact” information like serial head CT scans and clinical assessments for diagnosis. By the time neurological deterioration is evident, it may be too late to mitigate the damage caused by PICH.

Therefore, predictive models providing early warnings of potential PICH could enable medical teams to intervene and address this potentially severe complication promptly.

 

 

Progression of Intracranial Hemorrhage (PICH) 

 

Our team has created a predictive model of PICH, and is working to validate it in independent datasets. Relevant papers:

  1. Hinson HE, Radabaugh HL, Li N, Fukuda T, Pollock J, Schreiber M, Rowell S, Ferguson AR. Predicting Progression of Intracranial Hemorrhage in the Prehospital TXA for TBI Trial. J Neurotrauma. 2024 May 8. doi: 10.1089/neu.2023.0626. PMID: 38618713
  2. Hinson HE, Li P, Myers L, Agarwal C, Pollock J, McWeeney S. Incorporating Immunoproteins in the Development of Classification Models of Progression of Intracranial Hemorrhage After Traumatic Brain Injury. J Head Trauma Rehabil. 2021 Sep-Oct 01;36(5):E322-E328.
  3. Fair KA, Farrell DH, McCully BH, Rick EA, Dewey EN, Hilliard C, Dean R, Lin A, Hinson H, Barbosa R, Schreiber MA, Rowell SE. Fibrinolytic Activation in Patients with Progressive Intracranial Hemorrhage after Traumatic Brain Injury. J Neurotrauma. 2021 Apr 15;38(8):960-966.
  4. Anderson TN, Hwang J, Munar M, Papa L, Hinson HE, Vaughan A, Rowell SE. Blood-based biomarkers for prediction of intracranial hemorrhage and outcome in patients with moderate or severe traumatic brain injury. J Trauma Acute Care Surg. 2020 Jul;89(1):80-86.