Clinical characteristics and prognosis analysis of children with traumatic intracranial hemorrhage complicated by secondary brain swelling

SU Jianyun; GENG jingzhi; QIANG Zhaozhan; YANG Zhangkai; SHI Yongqiang; ZHANG Gang; MA Yonghong; SHI Hangyu

doi:10.13798/j.issn.1009-153X.2025.11.005

Abstract：Objective To explore the clinical characteristics and prognosis of children with traumatic intracranial hemorrhage complicated by secondary brain swelling.Methods The clinical data of 41 children with intracranial hemorrhage complicated by secondary brain swelling,admitted to the Department of Neurosurgery,Children's Hospital Affiliated to Xi'an Ji-aotong University between January 2019 and December 2023,were retrospectively analyzed.Results Brain swelling predom-inantly occurred in infants aged 1-6 years(61.0%).Traffic accidents were the most common cause(48.8%),followed by falls(34.1%).Traumatic subarachnoid hemorrhage was the most frequent presentation(53.7%),and pupillary changes were common(46.3%).Hemispheric brain swelling was observed in 20 cases,and diffuse brain swelling in another 20 cases.The time to onset of brain swelling ranged from 2 to 96 hours post-injury,with a median time of 8 hours.The median times for brain swelling on-set were 5 hours in the early-onset group(<24 hours)and 24 hours in the delayed-onset group(>24 hours).There were 29 cases(70.7%)in the early-onset group and 12 cases(29.3%)in the delayed-onset group.Children in the early-onset group exhibited early pupillary changes,elevated white blood cell count,and decreased fibrinogen levels,had higher Rotterdam CT scores,and despite surgical intervention,had poorer prognoses.Children in the delayed-onset group showed a trend of decreased mean ar-terial pressure and prolonged activated partial thromboplastin time upon admission;most were managed non-surgically and had better prognoses.At 1 year post-injury,the Glasgow Outcome Scale(GOS)scores in the early-onset group were:5 points in 11 cases,4 points in 2 cases,3 points in 5 cases,2 points in 4 cases,and 1 point in 7 cases.In the delayed-onset group,GOS scores were:5 points in 7 cases,4 points in 1 case,2 points in 2 cases,and 1 point in 2 cases.Conclusion Early post-injury brain swelling and bilateral hemispheric swelling are associated with poor prognosis.Timely fibrinogen supplementation and main-taining adequate fluid resuscitation to improve cerebral perfusion are necessary.Close monitoring of coagulation abnormalities is essential to be vigilant for delayed brain swelling.