Risk Stratification for Traumatic Subarachnoid Hemorrhage Enlargement and Surgical Intervention: Guides to Follow-up Imaging in Trauma Patients

ABSTRACT BACKGROUND AND PURPOSE: Traumatic subarachnoid hemorrhage (tSAH) is common after head trauma, but its clinical course and optimal imaging follow-up remain unclear. The purpose of this study is to identify predictors of SAH enlargement and neurosurgical intervention in patients with traumatic SAH and to propose a risk-based imaging algorithm. MATERIALS AND METHODS: We conducted a retrospective study of 250 patients with traumatic subarachnoid hemorrhage (tSAH) evaluated over a 6-year period. After excluding 9 patients with suspected aneurysmal hemorrhage, 241 patients with primary traumatic SAH (tSAH) were analyzed. Clinical, laboratory, and imaging data were reviewed to identify factors associated with SAH enlargement and the need for surgical intervention. RESULTS: SAH enlargement occurred in 17% of patients who underwent follow-up CT. Predictors of enlargement included low Glasgow Coma Scale (GCS), presence of intraparenchymal hemorrhage (IPH), and elevated INR/PTT. Neurosurgical intervention was strongly associated with midline shift and IPH. Patients with isolated SAH and normal coagulation had a low risk of enlargement and rarely required intervention. CONCLUSIONS: A risk-based stratification model can identify patients at low, moderate, and high risk for SAH progression. This model may support more selective use of follow-up imaging and early intervention. ABBREVIATIONS: SDH = Subdural Hematoma; SAH = Subarachnoid Hemorrhage; EDH = Epidural Hematoma; IPH = Intraparenchymal Hemorrhage; ED = Emergency Department; NCCT = Non-Contrast Computed Tomography; OR = Odds Ratio; TBI = Traumatic Brain Injury; tSAH = Traumatic Subarachnoid Hemorrhage; CTA = Computed Tomography Angiography.