(1586) Multicenter Study Examining Temporal Trends in Traumatic Intracranial Hemorrhage: 2016 to 2022

Introduction: Traumatic Intracranial hemorrhage (tICH) is a leading cause of death and disability and accounts for up to 50% of all trauma fatalities. The aging US population has altered the epidemiology of traumatic injury. The study objective was to examine changes in epidemiology of tICH including incidence, characteristics, severity, management, and outcomes.

Methods: This retrospective cohort study included trauma admissions to six US Level I/II trauma centers from 1/1/2016 – 7/15/2022. Patients with tICH (subdural, epidural, subarachnoid, and intracerebral hemorrhage) were identified by ICD-10 diagnosis codes. Cochran-Armitage trend tests were used to analyze changes over time, p< 0.05.

Results: There were 73,546 trauma admissions and 12,674 (17%) had a diagnosis of tICH, which significantly increased over time from 14% in 2016 to 19% in 2022 (+4%, p=0.003). Most patients (54%) were ≥65 years old, which increased over time (+5%, p< 0.001). The proportion of patients with comorbidities increased, with the largest increases in anticoagulant use (+14%), functional dependence (+14%), and hypertension (+7%), p< 0.001. There were no temporal changes in race, sex, and health insurance type. Falls were the most common mechanism (66%) and increased over time (+8%, p< 0.001). TBI severity did not change over time, based on ED GCS 3-8 (-3%, p=0.17) and head AIS ≥4 (-0.4%, p=0.83). The percent of patients neurosurgically managed did not change over time, overall (-1%, p=0.32), or among patients with ED GCS 3-8 (-3%, p=0.11). There were significant decreases in ICU admission over time (-16%, p< 0.001). In-hospital mortality from tICH was 9% and accounted for 48% of all trauma fatalities. Mortality significantly decreased over time (-3%, p< 0.001); however, there was a significant increase in discharge to hospice over time (+3%, p< 0.001), resulting in no overall change in near-term survival (-0.6%, p=0.18).

Conclusions: The incidence of tICH admissions are increasing and the demographics are shifting to older, frailer patients injured from falls, while TBI severity and neurosurgical management are unchanged. Implementation of BIG criteria may have affected ICU admission rates. The shift from in-patient death to hospice care suggests increased need for palliative care services.