Mild traumatic brain injury (mTBI) is a frequent cause of emergency head CT, although few exhibit intracranial hemorrhage (ICH). We aimed to update the distribution of ICH subtypes, identify clinical predictors and typical patient profiles

36-months retrospective multicenter study including consecutive adults with mTBI and head CT. Clinical variables were prospectively recorded, and imaging findings retrospectively extracted. ICH types were analyzed across clinical subgroups (age, sex, trauma mechanism, medication, alcohol intoxication and Glasgow coma scale (GCS)). Multivariable logistic regression identified independent predictors of ICH subtypes. Multiple correspondence analysis (MCA) and hierarchical clustering were applied to identify clinical profiles

Among 62,523 patients (median age 73.8 years), ICH was detected in 6.3% (3,927/62,523), with herniation in 7.9% of ICH cases. Subdural hematoma (SDH) was the most frequent (58.1%), followed by subarachnoid hemorrhage (SAH, 53.5%), intraparenchymal hemorrhage (IPH, 19.8%), and epidural hematoma (5.2%). Most ICHs were isolated (71.8%). ICH prevalence was higher when GCS was 13–14 (11.3–12%) and high-energy falls (10.6%). Younger patients frequently presented with isolated SAH, whereas SDH increased with age. Alcohol was associated with SAH (OR=1.18, p=0.0484) and IPH (OR=1.29, p=0.0394). Antiplatelet therapy was associated with SAH (OR=1.20, p=0.0174). Suspected skull vault fracture was the strongest predictor of all ICH (all ORs>30, p-values <0.0001). Unsupervised MCA–clustering identified three patient profiles associated with specific ICH patterns.

In mTBI, fewer than 1 in 15 head CTs showed ICH, often isolated and uncomplicated. Distinct clinical profiles based on pre-CT variables were associated with specific hemorrhage patterns.

In mTBI, fewer than 1 in 15 head CTs showed ICH, often isolated and uncomplicated. Distinct clinical profiles based on pre-CT variables were associated with specific hemorrhage patterns.