Midline shift and systolic hypertension strongly predict progression in conservatively managed mild TBI with intracranial hemorrhage

In 114 adults with mild TBI and ICH, 22.8% later deteriorated. Midline shift (OR 11.6), SBP ≥160 mmHg (OR 5.5), multiple ICHs (OR 3.7), and GCS 13–14 (OR 4.9) independently predicted need for admission or neurosurgery. Retrospective single-center data.

• Retrospective review of 114 adult patients with GCS 13–15 and radiologically confirmed ICH, managed conservatively at a single Thai ED, 2019–2023.
• Independent predictors of progression: midline shift (OR 11.58, 95%CI 2.93–45.78), SBP ≥160 mmHg (OR 5.49, 95%CI 1.69–17.77), multiple ICH (OR 3.69, 95%CI 1.13–11.98), initial GCS 13–14 (OR 4.86, 95%CI 1.18–20.08).
• Key limitations: single-center, retrospective design, small sample (n=114), selection bias from requiring repeat CT, and limited external validity.

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