The Role of Platelet Indices in Predicting Intracranial Hemorrhage in Emergency Department Patients With Head Trauma

Abstract

Background:
Traumatic brain injury (TBI) is a critical public health issue, particularly among young adults, and the presence of intracranial hemorrhage (ICH) has a direct impact on clinical outcomes. In patients presenting with mild head trauma, early prediction of ICH remains challenging. In recent years, hematologic biomarkers such as platelet indices have attracted increasing interest as potential diagnostic tools in trauma evaluation.

Objective:
This study aimed to investigate the association between platelet indices—including mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR), and the presence of ICH in patients presenting to the emergency department (ED) with isolated head trauma.

Methods:
This retrospective observational study included adult patients aged ≥18 years who presented to the ED with isolated head trauma between March 1, 2023 and March 1, 2024. Patients were divided into two groups based on the presence or absence of ICH on brain computed tomography. Hematological and biochemical parameters were recorded, and comparisons between the groups were conducted using appropriate parametric and non-parametric tests (significance level set at p <0.05).

Results:
A total of 215 patients were included to the trial, of whom 45 (20.9%) had confirmed ICH. White blood cell (WBC) counts were significantly higher in the ICH group (11.6 ± 4.0 vs. 9.6 ± 3.5; p = 0.003). No significant differences were observed between groups for MPV (p = 0.484), PDW (p = 0.724), or P-LCR (p = 0.567). Similarly, no significant associations were found between platelet indices and emergency department disposition.

Conclusion:
While WBC count was associated with both the presence of ICH and hospital admission, MPV, PDW and P-LCR did not demonstrate predictive value for ICH in patients with isolated head trauma. Further prospective, multicenter studies with serial measurements are needed to clarify the clinical utility of these indices in neurotrauma.