The Association of Fall Mechanism, Leukocyte Count, and Glucose Level With Undesirable Outcomes in Patients With Blunt Trauma Intracranial Hemorrhage: A Retrospective Study

Objective This study aimed to compare ground-level fall (GLF) with other mechanisms, admission white blood cell count (WBC), and blood glucose levels to determine their associations with multiple undesirable outcomes, including hospital death, increased ICU stay, increased hospital stay, adverse outcomes, not following commands at hospital discharge, and the need for mechanical ventilation. Methods Patients with intracranial hemorrhage (ICH) on CT, an admission Glasgow Coma Scale (GCS) score of 3-15, and blunt trauma were included. The brain CT Abbreviated Injury Scale score (ICH AIS) and Injury Severity Score (ISS) were obtained from the trauma registry. The extracranial (EC)-ISS was calculated as (the total ISS) - (the ICH AIS)2. An electronic medical record audit was performed to categorize injury mechanisms and retrieve WBC and glucose levels. An adverse outcome was defined as hospital death, ICU stay of ≥2 days, or hospital stay of >5 days. Hypotension was defined as an admission systolic blood pressure <100 mmHg. Hyperglycemia was defined as a glucose level ≥150 mg/dL. Leukocytosis was defined as a WBC ≥13.0/µL. Results The cohort consisted of 1,545 patients with ICH. The WBC and glucose values were available in 99% of patients. Non-GLF patients had higher proportions of age <70 years, GCS 3-12, ISS ≥16, hypotension, hyperglycemia, leukocytosis, death, ICU stay ≥2 days, hospital stay >5 days, an adverse outcome, not following commands at hospital discharge, and a need for mechanical ventilation (p≤0.01). Hyperglycemia had univariate associations with death, ICU stay ≥2 days, hospital stay >5 days, an adverse outcome, not following commands at hospital discharge, and a need for mechanical ventilation (p<0.01). Leukocytosis had univariate associations with death, ICU stay ≥2 days, hospital stay >5 days, an adverse outcome, not following commands at hospital discharge, and a need for mechanical ventilation (p<0.01). Hospital death showed an independent association with decreased GCS (p<0.01), increased ICH AIS, and hypotension (p=0.01). Increased ICU stay showed an independent association with decreased GCS (p<0.01), increased EC-ISS (p<0.01), increased ICH AIS (p<0.01), hyperglycemia (p<0.01), and leukocytosis (p<0.01). Increased hospital stay showed an independent association with decreased GCS (p<0.01), increased EC-ISS (p<0.01), increased ICH AIS (p<0.01), hyperglycemia (p<0.01), and leukocytosis (p<0.01). An adverse outcome showed an independent association with decreased GCS (p<0.01), increased EC-ISS (p<0.01), hypotension (p=0.01), increased ICH AIS (p<0.01), hyperglycemia (p<0.01), and leukocytosis (p<0.01). Not following commands at hospital discharge showed an independent association with decreased GCS (p<0.01) and increased ICH AIS (p<0.01). The need for mechanical ventilation showed an independent association with decreased GCS (p<0.01), increased EC-ISS (p<0.01), increased ICH AIS (p<0.01), hyperglycemia (p<0.01), and leukocytosis (p<0.01). Conclusions When compared with GLF patients, those with other blunt trauma mechanisms have worse risk profiles and poorer outcomes among patients with ICH. Stress leukocytosis and hyperglycemia were frequently found to be associated with multiple poor outcomes. Future investigators should consider incorporating stress leukocytosis and hyperglycemia as indicators of risk conditions that likely stem from catecholamine responses after trauma.