Management of older adults after mild head trauma in an oral and maxillofacial surgery clinic

Sakkas, Andreas; Weiß, Christel; Scheurer, Mario; Pietzka, Sebastian; Wilde, Frank; Qasim, Muhammad; Thiele, Oliver C.; Mischkowski, Robert A.; Ebeling, Marcel

doi:10.1007/s41999-023-00781-2

Cited by 3 publications

(13 citation statements)

References 57 publications

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“…The records were retrieved from the hospital's electronic database. Ethical approval for this research was obtained from the ethics committee of the chamber of physicians in Rhineland-Palatine, Mainz, Germany, in the context of a large retrospective trauma data evaluation with different aims and variable scientific issues (approval number: 2018-13524, approval date: 24 July 2018) [3,4].…”

Section: Patient Collectionmentioning

confidence: 99%

“…Patients who met the following inclusion criteria were enrolled: (1) age, (2) head trauma, (3) a GCS score of 13-15 at admission, (4) loss of consciousness for less than 30 min, and (5) amnesia less than 24 h. The exclusion criteria were: (1) no cranial CT imaging at admission, (2) a GCS score of <13, (3) loss of consciousness for 30 min or longer, (4) amnesia for 24 h or longer, and (5) incomplete medical records [3,4].…”

Section: Patient Collectionmentioning

confidence: 99%

“…A repeat cranial CT scan was performed in case of alterations in their neurological status. Neurological deterioration was defined as a decrease in the GCS score, a decrease in the level of consciousness, or the development of focal neurological deficits, such as worsening cephalgia, nausea, vomiting, vision changes, or dizziness [3,4]. Control CT scans of patients with positive CT0 findings were performed within 6-8 h after the initial scan.…”

Section: Patient Screeningmentioning

confidence: 99%

“…Unstable patients at the initial examination were admitted to the intensive care unit (ICU) for primary monitoring and stabilization. Any necessary neurosurgical interventions were performed in the neurosurgery department of a nearby hospital after telemedical consultation, due to the absence of a neurosurgery unit in the center [3,4].…”

Section: Patient Screeningmentioning

confidence: 99%

“…Traumatic brain injury is a common etiology of admission to emergency departments, with an economic impact on health systems [1]. Mild traumatic brain injury (mTBI) is defined by loss of consciousness for less than 30 min, amnesia for less than 24 h, psychiatric alteration, or focal neurological deficits, and an initial score of 13-15 on the Glasgow Coma Scale (GCS) [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Indicators for Primary Cranial CT Imaging after Mild Traumatic Brain Injury—A Retrospective Analysis

Sakkas

Weiß

Ebeling

et al. 2023

JCM

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The primary aim was to determine the clinical indicators for primary cranial CT imaging in patients after mild traumatic brain injury (mTBI). The secondary aim was to evaluate the need for post-traumatic short-term hospitalization based on primary clinical and CT findings. This was an observational retrospective single-centre study of all the patients who were admitted with mTBI over a five-year period. Demographic and anamnesis data, the clinical and radiological findings, and the outcome were analyzed. An initial cranial CT (CT0) was performed at admission. Repeat CT scans (CT1) were performed after positive CT0 findings and in cases with in-hospital secondary neurological deterioration. Intracranial hemorrhage (ICH) and the patient’s outcome were evaluated using descriptive statistical analysis. A multivariable analysis was performed to find associations between the clinical variables and the pathologic CT findings. A total of 1837 patients (mean age: 70.7 years) with mTBI were included. Acute ICH was detected in 102 patients (5.5%), with a total of 123 intracerebral lesions. In total, 707 (38.4%) patients were admitted for 48 h for in-hospital observation and six patients underwent an immediate neurosurgical intervention. The prevalence of delayed ICH was 0.05%. A Glasgow Coma Scale (GCS) of <15, loss of consciousness, amnesia, seizures, cephalgia, somnolence, dizziness, nausea, and clinical signs of fracture were identified as clinical factors with significantly higher risk of acute ICH. None of the 110 CT1 presented clinical relevance. A GCS of <15, loss of consciousness, amnesia, seizures, cephalgia, somnolence, dizziness, nausea, and clinical signs of cranial fractures should be considered absolute indicators for primary cranial CT imaging. The reported incidence of immediate and delayed traumatic ICH was very low and hospitalization should be decided individually considering both the clinical and CT findings.

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Section: Patient Collectionmentioning

confidence: 99%

Section: Patient Collectionmentioning

confidence: 99%

Section: Patient Screeningmentioning

confidence: 99%

Section: Patient Screeningmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Clinical Indicators for Primary Cranial CT Imaging after Mild Traumatic Brain Injury—A Retrospective Analysis

Sakkas

Weiß

Ebeling

et al. 2023

JCM

Self Cite

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Effects of preinjury oral anticoagulants on the outcomes of traumatic brain injury in elderly patients: a systematic review and meta-analysis

Karamian,

Seifi,

Lucke-Wold

2024

Brain Injury

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Justification of Indication for Cranial CT Imaging after Mild Traumatic Brain Injury According to the Current National Guidelines

et al. 2023

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The primary aim was to evaluate the compliance of cranial CT indication with the national guideline-based decision rules in patients after mTBI. The secondary aim was to determine the incidence of CT pathologies among justified and unjustified CT scans and to investigate the diagnostic value of these decision rules. This is a retrospective, single-center study on 1837 patients (mean age = 70.7 years) referred to a clinic of oral and maxillofacial surgery following mTBI over a five-year period. The current national clinical decision rules and recommendations for mTBI were retrospectively applied to calculate the incidence of unjustified CT imaging. The intracranial pathologies among the justified and unjustified CT scans were presented using descriptive statistical analysis. The performance of the decision rules was ascertained by calculating the sensitivity, specificity, and predictive values. A total of 123 intracerebral lesions were radiologically detected in 102 (5.5%) of the study patients. Most (62.1%) of the CT scans strictly complied with the guideline recommendations, and 37.8% were not justified and likely avoidable. A significantly higher incidence of intracranial pathology was observed in patients with justified CT scans compared with patients with unjustified CT scans (7.9% vs. 2.5%, p < 0.0001). Patients with loss of consciousness, amnesia, seizures, cephalgia, somnolence, dizziness, nausea, and clinical signs of cranial fractures presented pathologic CT findings more frequently (p < 0.05). The decision rules identified CT pathologies with 92.28% sensitivity and 39.08% specificity. To conclude, compliance with the national decision rules for mTBI was low, and more than a third of the CT scans performed were identified as “likely avoidable”. A higher incidence of pathologic CT findings was detected in patients with justified cranial CT imaging. The investigated decision rules showed a high sensitivity but low specificity for predicting CT pathologies.

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Management of older adults after mild head trauma in an oral and maxillofacial surgery clinic

Cited by 3 publications

References 57 publications

Clinical Indicators for Primary Cranial CT Imaging after Mild Traumatic Brain Injury—A Retrospective Analysis

Clinical Indicators for Primary Cranial CT Imaging after Mild Traumatic Brain Injury—A Retrospective Analysis

Effects of preinjury oral anticoagulants on the outcomes of traumatic brain injury in elderly patients: a systematic review and meta-analysis

Justification of Indication for Cranial CT Imaging after Mild Traumatic Brain Injury According to the Current National Guidelines

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