Table 4.
Clinical Management and Diagnosis
| Author | Aim of study | Country | Methodology | Sample size | Period | Outcome measures | Summary of findings |
|---|---|---|---|---|---|---|---|
| Wong 2011 | To investigate neurological outcome among head injury patients by examining the prognostic values of CT patterns of TSAH, in particular, the thickness and distribution | China | Prospective cohort | Jan 2006–Dec 2008 | 661 | • GOS | • Maximum thickness (mm) of SAH was independently associated with neurological outcome and death |
| Brelie 2015 | To analyze the clinical course and identify risk factors for potential clinical and radiologic deterioration in consideration of impaired coagulation in patients with iTSAH | Germany | Retrospective case series | 2003–2014 | 89 | • Radiographical progression • Clinical deterioration • Impaired coagulation |
• Radiological progression: 28.1%. • Clinical deterioration: 6.7%. • Impaired coagulation: 38% • Radiological and clinical deterioration were significantly associated with elevated INR |
| Chieregato 2005 | To identify the factors that may predict outcomes and changes in the CT scans of lesions in a selected population of TSAH patients | Italy | Prospective cohort | Jan 1997–Jan1999 | 141 | • GOS | • Unfavorable GOS: 19.9% (n = 28) • Unfavorable GOS related to age, GCS score at admission, Marshall CT score at admission, amount of subarachnoid blood, and volume of the associated contusion |
| Lee 2014 | To provide a more comprehensive assessment of iTSAH among patients with any GCS score and to expand the analysis to examine the potential need for aggressive medical, endovascular, or open surgical interventions in these patients | USA | Retrospective cohort | Jan 2003 – Dec 2012 | 661 | • Aggressive procedural intervention • Mortality • Hospital transfer |
• Aggressive neurosurgical, medical, or endovascular intervention: 0.61% (n = 4) • Mortality: 1.7% (n = 6) • 68% of patients without additional systemic injury were discharged |
| Lin 2012 | To investigate the impact of TSAH on outcome and clarify the role of various TSAH subgroups and to discuss the possible underlying mechanism linking certain TSAH with specific outcomes | Taiwan | Prospective cohort | 3 years | 117 | • GOS | • Age, severity of head injury, and extensiveness of subarachnoid blood are independent predictors of poor outcome |
| Rau 2017 35 | To construct a model for iTSAH mortality prediction using a decision tree algorithm | Taiwan | Retrospective cohort | 2009–2016 | 545 | • Mortality | • 60% of those with a head AIS >4 died • 57% of those with an AIS score ≤4, but Cr ≥1.4 and age ≥76 years died |
| Rau 2019 | To estimate the risk of mortality in adult trauma patients with TSAH and concurrent intracranial hemorrhages compared with the risk in patients with iTSAH. | Taiwan | Cross–sectional | Jan 2009– Dec 2018 | 1,856 | • Mortality | • iTSAH: 1.8% • SAH + one diagnosis: 7.9% • SAH + two diagnoses: 12.4% • SAH + three diagnoses: 27.3% |
| Vergouwen 2006 | To evaluate the effect of nimodipine on outcome in patients with TSAH | Netherlands | Systematic review | Up to 2006 | 1,074 | • GOS • Mortality |
• Occurrence of poor outcome and mortality was similar in nimodipine or placebo |
| Mata–Mbemba 2018 | To test the hypothesis that midline TSAH on initial CT may implicate the same shearing mechanism that underlies severe diffuse axonal injury (DAI) | Japan | Prospective cohort | 270 | Jan 2009 – Dec 2013 | • GOSE | • The midline TSAH independently predicted poor GOSE score at both hospital discharge and after 6 months |
CT, computed tomography; TSAH, traumatic subarachnoid hemorrhage; GOS, Glasgow Outcome Score; SAH, subarachnoid hemorrhage; iTSAH, isolated traumatic subarachnoid hemorrhage; INR, International Normalized Ratio; GCS, Glasgow Coma Scale; AIS, American Injury Scale; Cr, creatinine; GOSE, Extended Glasgow Outcome Score; DAI, diffuse axonal injury.