Among 114 adults with GCS 13-15, intracranial haemorrhage, conservative management and repeat CT, 26 (22.8%) progressed to admission or neurosurgical intervention. Midline shift, systolic blood pressure ≥160, multiple haemorrhages and GCS 13-14 were independently associated. These are triage signals, not an externally validated rule.
Key findings
- Progression occurred in 26/114 (22.8%). Midline shift had OR 11.58 (95% CI 2.93-45.78), SBP≥160 OR 5.49 (1.69-17.77), multiple haemorrhages OR 3.69 (1.13-11.98), and GCS 13-14 OR 4.86 (1.18-20.08).
Why this matters globally
Selecting patients for observation and repeat CT is a global balance between missed deterioration, radiation, beds and neurosurgical resources.
Thai researcher contribution
Mahidol and Ramathibodi researchers linked practical Thai ED findings with clinically meaningful deterioration.
Limitations to consider
Single-centre retrospective selection of patients already given repeat CT introduces bias. Only 26 events risk overfitting and wide intervals; hypertension may reflect pain/stress, and admission depends on local policy.