Risk factors associated with secondary delayed contralateral expanding hematoma in patient with bilateral acute traumatic intracranial hematomas

Abstract

Background: Secondary delayed contralateral expanding hematoma (SDCEH) may occur after unilateral surgery in patients with bilateral acute traumatic intracranial hematomas and can lead to neurological deterioration. Identifying patients at risk may help guide early postoperative imaging and timely intervention.
Methods: We performed a retrospective cohort study of adult patients with bilateral acute traumatic intracranial hematomas who underwent unilateral surgical evacuation at a Level I trauma center between January 2021 and February 2024. Postoperative CT was obtained within 24 hours based on predefined clinical criteria. SDCEH was defined as a postoperative increase in contralateral hematoma volume or thickness by >30% requiring contralateral surgical intervention. Patients were categorized into progression (SDCEH) and non-progression groups. Variables associated with SDCEH were assessed using univariate analysis and multivariable logistic regression.
Results: Sixty-one patients were included; 29 (47.5%) developed SDCEH. On univariate analysis, midline shift, contralateral skull fracture, and postoperative coagulopathy were associated with SDCEH. In multivariable analysis, contralateral skull fracture (p=0.048) and postoperative coagulopathy (p=0.011) remained independent predictors, whereas midline shift was not significant after adjustment.
Conclusions: SDCEH occurred in nearly half of patients with bilateral acute traumatic intracranial hematomas treated with unilateral surgery. Contralateral skull fracture and postoperative coagulopathy independently predicted SDCEH. Patients with these features may benefit from intensive postoperative surveillance and early serial CT imaging to facilitate prompt detection and management.