How Long Should Patients with Intracranial Hemorrhage Be Observed?

Q: How Long Should Patients with Intracranial Hemorrhage Be Observed?

Hello： Intracerebral hemorrhage is most dangerous in the first 8 hours. <br>After that, continuous observation is required for 24-48-72 hours. <br>As time passes, the risk of worsening and expansion of the hemorrhage gradually decreases. <br>It is speculated that your classmate m

Observation period for intracranial hemorrhage?

Dear Dr.
Lai,
I would like to inquire about the observation and management protocols in the hospital.
My classmate, a 20-year-old, was involved in a car accident on February 12th around 4 PM.
He was conscious upon arrival at the hospital, able to recognize people, but could not recall the circumstances of the accident.
He also vomited once.
The hospital performed a CT scan and diagnosed him with a brain hemorrhage.
The doctor advised that he should be hospitalized for observation overnight, and if there was no further bleeding the next day, he could be discharged.
However, we found information online suggesting that at least three days of observation is recommended.
I would like to ask if the standard procedure for managing brain hemorrhages typically involves determining the severity of the hemorrhage to decide whether the patient should be sent home for observation or remain hospitalized.
Given that the nearby hospitals are unable to perform surgery if there is ongoing intracranial bleeding (it takes about half an hour to reach a hospital that can perform surgery), would it be advisable to transfer him to a facility where he can be monitored for a few more days?
My classmate does not have family in Taiwan to care for him, so I want to ensure we have all the necessary information to avoid any delays in his care.
I sincerely appreciate your attention to this matter, and I would be extremely grateful for any clarification you can provide.
Thank you!

Abby, 20~29 year old female. Ask Date: 2022/02/13

Dr. Lai Zhaokang reply Neurosurgery

Hello: Intracerebral hemorrhage is most dangerous in the first 8 hours.
After that, continuous observation is required for 24-48-72 hours.
As time passes, the risk of worsening and expansion of the hemorrhage gradually decreases.
It is speculated that your classmate may have had a relatively minor hemorrhage or only suspected bleeding, which is why the original physician arranged it this way.
As you mentioned, if the nearby hospital truly cannot perform surgery for ongoing intracranial bleeding, it may be advisable to consider treatment and follow-up at a hospital with a neurosurgery specialist, as this is likely to provide more detailed and professional care.
Best wishes to you all.
// Changhua Hospital Neurosurgery Dr.
Lai Chao-Kang

Reply Date: 2022/02/13

More Info

When it comes to the observation period for patients with intracranial hemorrhage, the duration can vary significantly based on several factors, including the severity of the hemorrhage, the patient's clinical status, and the specific protocols of the treating facility. In general, the initial observation period for patients with mild to moderate intracranial hemorrhage is typically at least 24 to 72 hours, but this can extend longer depending on the circumstances.

In your friend's case, who is a 20-year-old involved in a car accident and subsequently diagnosed with a brain hemorrhage, the decision to observe for one night may seem brief, especially considering the potential risks associated with intracranial bleeding. The first 8 hours post-injury are critical, as this is when the risk of deterioration is highest. After this initial period, continued monitoring for an additional 24 to 72 hours is often recommended to ensure that there are no complications, such as an increase in the size of the hemorrhage or the development of new symptoms.

The decision to discharge a patient or to continue hospitalization is typically based on the patient's neurological status, the size and location of the hemorrhage, and any accompanying symptoms. For example, if a patient is alert, oriented, and shows no signs of increased intracranial pressure or neurological decline, a physician may decide that it is safe to discharge them after a short observation period. However, if there are any concerns about the patient's condition, or if the hemorrhage is significant, further observation in a hospital setting may be warranted.

Given your concern about the local hospital's capability to manage potential complications, it may be prudent to consider transferring your friend to a facility that has neurosurgical capabilities. This is particularly important if there is any indication that the hemorrhage could worsen or if the patient exhibits any concerning symptoms, such as severe headache, vomiting, confusion, or changes in consciousness. A transfer to a hospital equipped to handle neurosurgical emergencies would provide peace of mind and ensure that your friend has access to timely intervention if needed.

In summary, while a one-night observation may be sufficient for some patients with mild intracranial hemorrhage, it is essential to consider the individual circumstances and the potential risks involved. If there are any doubts about the adequacy of the observation or the ability of the local hospital to manage complications, seeking a second opinion or transferring to a more equipped facility is a reasonable course of action. Always prioritize the patient's safety and well-being, and do not hesitate to advocate for more extensive observation if warranted.

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