Ris factors for the progression of intracranial hemorrhages in the acute phase of traumatic brain injury. A literature review

Abstract

The progression of traumatic intracranial hematomas is one of the key mechanisms of secondary brain damage in traumatic brain injury and significantly determines the clinical course of the disease, the need for repeated neurosurgical interventions, and functional outcomes. Objective. To summarize the risk factors for the progression of traumatic intracranial hematomas of various localization and to assess their clinical and pathophysiological significance. Materials and methods. An analytical review of domestic and foreign publications on the progression of traumatic intracranial hematomas was performed, including systematic reviews, meta-analyses, cohort studies, and radiomics/predictive modeling. Results. The most persistent risk factors remain systemic post-traumatic coagulopathy, low fibrinogen levels, thrombocytopenia, increased D-dimer levels, prolonged prothrombin time / increased international normalized ratio, signs of early hyperfibrinolysis, low Glasgow Coma Scale scores upon admission to the hospital, and the presence of concomitant subarachnoid or subdural hemorrhages, displacement of midline structures, and signs of active bleeding on neuroimaging. New data shows that 3D volumetry, radiomic models, and combined clinical and radiological nomograms can improve the accuracy of early risk stratification, but they still require external validation. Conclusion. Progression of traumatic intracranial hematomas is a multifactorial secondary injury process; risk profiles differ by hematoma type and require differentiated monitoring, hemostatic correction and risk-oriented repeat neuroimaging.