AIM: To investigate the risk factors and potential preventive measures of delayed intracranial hematoma (DIH) following severe traumatic brain injury (sTBI).

METHODS: Clinical data from 132 patients with sTBI who underwent decompressive craniectomy between January 2022 and December 2024 were retrospectively analyzed. The control group (102 cases) did not develop delayed intracranial hematoma postoperatively, while the study group (30 cases) experienced DIH. General clinical characteristics were compared between the two groups, and multivariate logistic regression was used to identify risk factors associated with DIH following sTBI.

RESULTS: No significant differences were observed in age, sex, pupil changes, prothrombin time, hematoma volume, subdural hematoma, or cerebral contusion between the two groups (p > 0.05). The study group exhibited longer thrombin time (TT) and activated partial thromboplastin time (APTT), higher systolic and diastolic blood pressures, and lower fibrinogen levels (all p < 0.05). A greater proportion of patients in the study group had a Rotterdam computed tomography (CT) score >3, Glasgow Coma Scale (GCS) ≤8, skull fractures, and epidural hematoma (all p < 0.05). Logistic regression analysis identified preoperative Rotterdam CT score >3, GCS ≤8, prolonged TT, elevated diastolic blood pressure (DBP), and systolic blood pressure (SBP) as independent risk factors for postoperative DIH (p < 0.05).

CONCLUSIONS: Independent risk factors for DIH following decompressive craniectomy in patients with sTBI include a preoperative Rotterdam CT score >3, skull fractures, prolonged TT, and elevated DBP and SBP. Early, targeted preventive strategies and timely interventions for high-risk patients may help reduce the incidence of DIH following sTBI. Larger, multicenter studies are warranted to validate these findings and identify additional contributing factors.