Traumatic Intracranial hemorrhage (TICH) is one of the commonest indications for neurosurgical consultation following trauma. Worsening neurological exam, size of initial TICH, presence of displaced skull fracture, and concomitant anticoagulant use at the time of injury drive the recommendations for repeat computed tomography of head (RCTH), to assess for stability of ICH. Chronic alcohol use is not generally considered an indication for repeat head CT.
A retrospective study of 423 TICH patients with normal admission platelet counts was reviewed for this study, taken as a subset of 1330 TICH patients admitted to Lahey Hospital and Medical Center over a 3-year period. Of these 423 patients, 330 were classified as non-alcoholics and 93 were classified as alcoholics, based upon whether alcohol use disorder was documented in the patient’s medical record, present prior to injury. The Normal platelet (PLT) level was defined as ≥100,000 μ/L. Patients were excluded from review if they had co-morbid conditions that could cause PLT dysfunction or coagulopathy. Continuous and categorical variables were compared using independent T test and chi square, respectively. Binary logistic regression was used to predict outcome: stable versus worsening of TICH on RCTH. Statistical analysis was conducted using SPSS 25.
The mean age of the non-alcoholic and alcoholic cohorts were 71.9 years and 54.8 years, respectively. A significantly higher percentage of alcoholics were male. There was a statistically significant difference (x 2 = 8.14, p<.004) in radiological progression of TICH between the two groups, with the alcoholics having a worsening RCTH 16.1% of the time compared to only 6.7% in non-alcoholics. Chronic alcohol use was an independent predictor of radiological progression in patients with normal PLT level (Odds ratio = 2.69, CI 1.34 – 5.43, p<.006).
Chronic alcohol use was an independent predictor of radiological progression of TICH in the setting of normal platelet level. Modification of this risk of progression with transfusion of fresh platelets in chronic alcoholic patients with TICH needs to be answered by a prospective trial.
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