Online Poster Portal

Specialty: Trauma Surgery/Surgical Critical Care

PART 1, Clinical Outcomes: Risk Factors for Progression of Intracranial Hemorrhage in Adult Patients with Traumatic Brain Injury

Keywords:

Traumatic brain injury, intracranial hemorrhage, progression

Background:

Progression of intracranial hemorrhage (ICH) on repeat CT imaging is a key concern in the management of traumatic brain injury (TBI) and may prompt escalation of care. However, the interplay of injury characteristics, hemorrhage pattern, and patient demographics remain unclear. We aim to identify independent predictors of radiographic progression in a cohort of patients with TBI.

Objective:

To identify risk factors for intracranial hemorrhage progression on repeat imaging in patients with traumatic brain injury.  

Methods:

We conducted a single-institution retrospective cohort study of adult patients with TBI and ICH who underwent repeat computed tomography (CT) imaging at Harbor-UCLA Medical Center’s Level I trauma center between 2022-2023. Patient demographics, comorbidities, medication use, laboratory values, injury characteristics, and imaging findings were collected. The primary outcome was radiographic progression of ICH on first repeat CTH, defined as any increase in hemorrhage size or presence of new hemorrhage. Univariate analyses were performed comparing patients with and without progression using Mann-Whitney U tests for continuous variables and chi-square or Fisher’s exact tests for categorical variables. To identify independent predictors of progression, multivariate logistic regression was performed using clinically relevant variables. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were reported.

Results:

A total of 420 patients with TBI and ICH were included, of whom 173 (41%) demonstrated radiographic hemorrhage progression on repeat CT imaging. In multivariable analysis, subarachnoid hemorrhage (OR 3.55, 95% CI 1.91-5.22, p<0.01), intraparenchymal hemorrhage (OR 2.64, 95% CI 1.48-4.69, p<0.01), and Injury Severity Score (ISS) (OR 1.07 per point, 95% CI 1.04–1.10, p<0.01) were independently associated with progression. Age, comorbidities, anticoagulation, dual antiplatelet therapy, GCS, and other ICH types (subdural hematoma, epidural hematoma, intraventricular hemorrhage) were not independently associated with progression (all p>0.05).

Conclusions:

Progression of intracranial hemorrhage in TBI patients is driven by overall injury burden and hemorrhage pattern, particularly subarachnoid and intraparenchymal hemorrhage. These findings identify high risk patients and may help guide the decision for reimaging, level of care, and monitoring intensity.

PART 2, Quality Improvement: Developing and Implementing an Inpatient Mental Health Screening Protocol for Trauma Surgery Patients at Harbor-UCLA Medical Center

Keywords: Trauma survivors, mental health screening, PTSD and depression

Background:

Trauma patients are at significantly high risk for mental health (MH) complications. Up to 20% of hospitalized trauma survivors experience depression or post-traumatic stress disorder (PTSD) with high rates of re-injury, disability and functional impairment, and suicide, especially if MH concerns are not addressed (1,2,3,4). Despite this, less than one third of Level I and II Trauma Centers in the United States screen patients for PTSD (1) with low rates of treatment among those who screen positive (5). Moreover, the American College of Surgeons (ACS) now requires that all Level I trauma centers adopt “a protocol to screen patients at high risk for psychological sequelae with subsequent referral to mental health provider"(6), highlighting the importance of MH care as part of trauma surgery treatment.  

Current Condition:

Harbor-UCLA Medical Center, a Level I Trauma Center in south Los Angeles, does not currently have a standardized protocol for MH screening of trauma patients. Chart review of all admitted trauma patients in June 2025 revealed that only 22.4% had any form of documented MH screening, mostly performed by social work and occasionally by psychiatry or geriatric medicine.

Target Conditions:  

Our goal is to develop and to implement a multidisciplinary MH screening protocol for all trauma patients admitted to Harbor-UCLA and to connect patients with MH resources immediately after their injuries while they are still inpatient. Furthermore, this program will assist with Harbor-UCLA’s reverification as an ACS Level I trauma center, given the updated ACS requirements.

Gap Analysis:

Deficiencies in MH screening and referrals likely exist due to lack of a standardized system triggering these services. This also results in variable screening quality when completed, with some patients receiving full biopsychosocial assessments and others only brief depression or suicide risk questionnaires.

Countermeasures:

We propose a multidisciplinary approach to MH screening to distribute the workload and to increase compliance. Our protocol is adopted from Moore et. al. at Henry Ford Hospital, who developed a trauma MH screening system including trauma surgery, psychiatry, and social work, and validated their proprietary Psychological Vulnerability Screening Questionnaire (P-VSQ). Patients who screened positive on the P-VSQ were twice as likely to receive MH referrals (7). Our protocol will similarly utilize the P-VSQ and be a joint effort between trauma surgery residents, nurse practitioners (NP), and attendings, nurses, and social work.

Action Plan:

We started a pilot study in two hospital units (third floor west wing surgical intensive care unit and step-down unit). The protocol begins with residents and NPs placing nurse communication orders to complete P-VSQ screening and nurses completing the screening on paper forms within 48 hours of admission. If a patient screens positive, the resident/NP consults social work for a full assessment including an Injured Trauma Survivor Screen and appropriate MH referrals. We are prospectively collecting data to assess the efficacy of this protocol in real time.  

Next Steps:

The next step of this project is to eventually implement the protocol throughout Harbor-UCLA for all admitted trauma patients. This phase will occur once we reach 80% compliance with the pilot workflow. Additionally, we are working to create a standardized electronic medical records form to streamline documentation. Eventually, we plan to track long term patient outcomes with MH referrals.

References

1. Bryant, R. A. (2011). Acute stress disorder as a predictor of posttraumatic stress disorder: A systematic review. Journal of Clinical Psychiatry, 72(2), 233–239. https://doi.org/10.4088/JCP.09r05072blu
2. Martin-Herz, S. P., McMahon, R. J., Malzyner, S., Chiang, N., & Zatzick, D. F. (2022). Impact of posttraumatic stress disorder and depressive symptoms on quality of life in adolescents after general traumatic injury. Journal of Traumatic Stress, 35(2), 386–397. https://doi.org/10.1002/jts.22750
3. Zatzick, D. F., Jurkovich, G. J., Rivara, F. P., Wang, J., Fan, M.-Y., Joesch, J., & Mackenzie, E. (2008). A national U.S. study of posttraumatic stress disorder, depression, and work and functional outcomes after hospitalization for traumatic injury. Annals of Surgery, 248(3), 429–437. https://doi.org/10.1097/SLA.0b013e318185a6b8
4. Herrera-Escobar, J. P., Seshadri, A. J., Stanek, E., Lu, K., Han, K., Sanchez, S., Kaafarani, H. M. A., Salim, A., Levy-Carrick, N. C., & Nehra, D. (2021). Mental health burden after injury: It’s about more than just posttraumatic stress disorder. Annals of Surgery, 274(6), e1162–e1169. https://doi.org/10.1097/SLA.0000000000003780
5. Bell TM, Vetor AN, Zarzaur BL. Prevalence and treatment of depression and posttraumatic stress disorder among trauma patients with non-neurological injuries. J Trauma Acute Care Surg. 2018;85(5):999-1006. doi:10.1097/TA.0000000000001992
6. American College of Surgeons. (2023). Best practices guidelines: Screening and intervention for mental health disorders and substance use and misuse in the acute trauma patient (Trauma Quality Programs Best Practices Guidelines). American College of Surgeons. https://www.facs.org/media/nrcj31ku/mental-health-guidelines.pdf
7. Moore, D. A. (2025, November). Development and utilization of a three-tiered model incorporating risk factor-based screening to meet mental health screening and referral requirements. Podium presentation at the 15th Annual Trauma Quality Improvement Program (TQIP) Conference, Chicago, IL.