Predicting the need for operation in the patient with an occult traumatic intracranial hematoma

Abstract

Computed tomography scanning has shown that acute traumatic intracranial hematomas are more common than was previously realized, but whether all hematomas must be removed remains controversial. About half of this series of 26 patients who were not clinically deteriorating and who were initially managed without operation had to undergo hematoma removal because of subsequent deterioration. Features present at the time of diagnosis (age, type and site of hematoma, presence of focal signs, level of responsiveness and degree of midline shift) were not helpful in predicting if operation would be needed. The only discriminatory factor was the level of intracranial pressure (ICP). All the patients with ICP > 30 mm Hg deteriorated and required operation, but only 1 patient whose ICP was < 20 mm Hg deteriorated. Half the patients with ICP of 20-30 mm Hg did not require an operation. Intracranial pressure monitoring can be useful in managing patients with an occult intracranial hematoma.