Multicompartmental hemorrhage: A high-risk pattern associated with increased risk for progression in TBI patients

BACKGROUND: Traumatic brain injury (TBI) with intracranial hemorrhage (ICH) often requires repeat head computed tomography (CT) imaging to monitor for bleed progression. While prior literature has explored patient-level factors, data on the impact of ICH morphologies (subdural [SDH], epidural [EDH], intraparenchymal [IPH], intraventricular [IVH], and multicompartment hemorrhage [MCH]) on radiographic ICH progression remains unclear. We hypothesized that MCH and IVH would have an increased associated risk of progression. METHODS: This retrospective (2021-2023) single-center cohort included adults (≥18 y) with TBI-related ICH who underwent initial and repeat head CT. Patients were stratified into radiographic progression versus no-progression cohorts, with progression defined as new or enlarging hemorrhage on attending radiologist interpretation of follow-up head CT. The primary outcome was the rate of radiographic progression for each ICH type. MCH was defined as the presence of two or more ICH types. Multivariable logistic regression was performed to evaluate the association between each ICH type and radiographic progression, adjusting for age, mechanism of injury, Injury Severity Score, Glasgow Coma Scale on arrival, trauma-bay intubation, and preinjury antithrombotic exposure. RESULTS: Of the 817 patients with ICH on initial head CT and documented repeat CT, 401 (49.1%) had radiographic progression. Patients with progression were younger (58 vs. 62 y, p=0.027), more frequently male (71.3% vs. 63.7%, p=0.020), and had similar antithrombotic exposure (15.2% vs. 14.2%, p=0.678). Craniotomy/craniectomy was more frequent among those with progression (21.2% vs. 8.2%, p<0.001). On multivariable analysis, MCH demonstrated the strongest associated risk for progression (odds ratio [OR] 5.60, 95% confidence interval [CI] 3.36-9.33, p<0.001), whereas IPH (OR 2.02, CI: 0.86-4.75, p=0.108), SDH, EDH, and IVH were not independently associated with radiographic ICH progression. CONCLUSIONS: MCH was independently associated with radiographic ICH progression. This higher-risk hemorrhage pattern may warrant closer neurological monitoring. LEVEL OF EVIDENCE: Prognostic/Epidemiologic; Level III.