Traumatic Hemorrhage Expansion feat. Caline Azzi

So let's talk across all three papers.

Would you say that the hemorrhage compartment is less important than the overall clinical and imaging phenotype?

The compartment still matters, but the broader phenotype appears more useful for risk stratification.

Across SDH, SAH, IPH, higher risk was consistently associated with features such as larger hemorrhage burden, multi-compartment injury, mass effect, coagulopathy, and a worse neurologic exam.

So the decision to repeat CT should not be based on the hemorrhage type alone.

And what findings would make you uncomfortable omitting repeat CT?

So I would be uncomfortable admitting repeating CT in a patient with a larger hemorrhage, like an initial larger hemorrhage, multi-compartment injury, midline shift or other some kind of mass effect, abnormal coagulation or a low declining glasgow coma scale, intravenous neurologic symptom development, skull fracture, intrametricular hemorrhage, hydrocephalus, or limited ability to monitor the patient would also favor a closer surveillance.

So it sounds like we can start formulating in our mind a scoring system or a decision tree of some sort.

And in your SAH paper, you and your coauthors proposed a practical algorithm for clinicians to determine imaging-related management.

Could you walk us through that algorithm?

Sure.

So the algorithm combines the imaging and clinical features to stratify patients into a low, moderate, and high-risk groups.

Low-risk patients with isolated traumatic subarachnoid hemorrhages and a stable neurologic exam may only require observation.

Moderate-risk patients may benefit from an early repeat CT, while high-risk patients, such as those with a low GSS, midline shift, larger associated hemorrhages, or severe coagulopathy, those require closer imaging surveillance and neurosurgical evaluation.

Unfortunately, this is a proposed framework.

It still requires prospective validation.