Risk of delayed intracranial haemorrhage after an initial negative CT in patients on DOACs with mild traumatic brain injury

Turcato, Gianni; Cipriano, Alessandro; Zaboli, Arian; Park, Naria; Riccardi, Alessandro; Santini, Massimo; Lerza, Roberto; Ricci, Giorgio; Bonora, Antonio; Ghiadoni, Lorenzo

doi:10.1016/j.ajem.2022.01.018

Cited by 11 publications

(4 citation statements)

References 23 publications

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“…The development of protocols for the identification of intracranial injuries in trauma victims is fundamental 20 , 21 . One of the biggest problems in trauma care is unnoticed injuries 2 .…”

Section: Discussionmentioning

confidence: 99%

Clinical assessment of head injuries in motorcyclists involved in traffic accidents: A prospective, observational study

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Brianti

Parreira

et al. 2022

Rev. Col. Bras. Cir.

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Objective: to review the clinical assessment of head injuries in motorcyclists involved in traffic accidents. Method: prospective observational study, including adult motorcyclists involved in traffic accidents in a period of 12 months. Patients sustaining signs of intoxication were excluded. A modification of the Canadian Head CT Rules was used to indicate computed tomography (CT). Patients not undergoing CT were followed by phone calls for three months. Collected variables were compared between the group sustaining head injuries and the others. We used chi-square, Fisher, and Student’s t for statistical analysis, considering p<0.05 as significant. Results: we included 208 patients, 99.0% were wearing helmets. Seventeen sustained signs of intoxication and were excluded. Ninety (47.1%) underwent CT and 12 (6.3%) sustained head injuries. Head injuries were significantly associated with Glasgow Coma Scale<15 (52.3% vs. 2.8% - p<0,001) and a positive physical exam (17.1% vs. zero - p<0,05). Four (2.1%) patients with intracranial mass lesions needed surgical interventions. None helmet-wearing patients admitted with GCS=15 and normal physical examination sustained head injuries. Conclusion: Head CT is not necessary for helmet-wearing motorcyclists admitted with GCS=15 and normal physical examination.

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Section: Discussionmentioning

confidence: 99%

Clinical assessment of head injuries in motorcyclists involved in traffic accidents: A prospective, observational study

Below

Brianti

Parreira

et al. 2022

Rev. Col. Bras. Cir.

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“…The definition varies, but usually ranges from an intracranial hemorrhage found within 24 h of trauma to 2 to 30 days [114]. Data about the frequency of dICI following an mTBI are very uncertain, ranging from 0.5 to 2% reported in some studies to 9 to 13% reported in others [35,39,41,61,[115][116][117][118][119].…”

Section: Delayed Intracranial Injuriesmentioning

confidence: 99%

“…These differences are, in part, consequences of methodological issues, such as an overall poor quality of the studies, mostly characterized by their retrospective design and affected by a high prevalence of missing or unclear data. Moreover, most of the studies enrolled mixed populations treated with different types of antithrombotic and antiaggregant therapies [120,121], while others enrolled only patients on DOAs [119,122]. Of course, this heterogeneity undermines the reliability of most of the SRs [35,39,[115][116][117].…”

Section: Delayed Intracranial Injuriesmentioning

confidence: 99%

Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department

Menditto,

Rossetti,

Sampaolesi

et al. 2024

JCM

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The best management of patients who suffer from traumatic brain injury (TBI) while on oral anticoagulants is one of the most disputed problems of emergency services. Indeed, guidelines, clinical decision rules, and observational studies addressing this topic are scarce and conflicting. Moreover, relevant issues such as the specific treatment (and even definition) of mild TBI, rate of delayed intracranial injury, indications for neurosurgery, and anticoagulant modulation are largely empiric. We reviewed the most recent evidence on these topics and explored other clinically relevant aspects, such as the promising role of dosing brain biomarkers, the strategies to assess the extent of anticoagulation, and the indications of reversals and tranexamic acid administration, in cases of mild TBI or as a bridge to neurosurgery. The appropriate timing of anticoagulant resumption was also discussed. Finally, we obtained an insight into the economic burden of TBI in patients on oral anticoagulants, and future directions on the management of this subpopulation of TBI patients were proposed. In this article, at the end of each section, a “take home message” is stated.

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“…Este estudo foi aprovado pelo Comitê de Ética em Pesquisa de nosso hospital (CAAE 59539216.9.0000.5479). O desenvolvimento de protocolos para identificação de lesões intracranianas em vítimas de trauma é fundamental 20,21 . Um dos maiores problemas no atendimento ao traumatizado são as lesões despercebidas 2 .…”

Section: Métodosunclassified

Investigação da presença de lesões traumáticas em segmento cefálico em motociclistas vítimas de acidentes de tráfego: Estudo observacional prospectivo

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Brianti

Parreira

et al. 2022

Rev. Col. Bras. Cir.

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RESUMO Objetivo: análise crítica da investigação diagnóstica de lesões em segmento cefálico de motociclistas vítimas de acidentes de tráfego. Método: estudo observacional prospectivo incluindo motociclistas adultos vítimas de trauma, sem intoxicação exógena, em um período de 12 meses. A tomografia de crânio (TC) foi indicada de acordo com uma modificação dos “critérios canadenses”. Os pacientes que não foram submetidos a TC de crânio tiveram acompanhamento telefônico por três meses. A presença de lesões foi correlacionada com as varáveis coletadas através dos testes Qui-quadrado, t de Student ou Fisher, considerando p<0,05 como significativo. Resultados: dos 208 inicialmente incluídos, 206 (99,0%) estavam usando capacete. Dezessete estavam com sinais de intoxicação exógena e foram excluídos, restando 191 para análise. Noventa pacientes (47,1%) realizaram TC e 12 (6,3%) apresentaram lesões craniencefálicas, que se associaram significativamente a Escala de Coma de Glasgow (ECG) <15 (52,3% vs. 2,8% - p<0,001) e alterações ao exame físico da região cefálica/neurológico (17,1% vs. zero - p<0,05). Quatro pacientes (2,1%) precisaram tratamento cirúrgico de lesões intracranianas. Nenhum dos pacientes admitidos com ECG 15, em uso de capacete e sem alterações no exame físico apresentou TC alterada. Conclusões: para pacientes admitidos com ECG 15, que utilizavam o capacete no acidente e não apresentavam quaisquer alterações no exame físico, a realização da TC de crânio não trouxe mudanças no atendimento ao paciente. .

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Risk of delayed intracranial haemorrhage after an initial negative CT in patients on DOACs with mild traumatic brain injury

Cited by 11 publications

References 23 publications

Clinical assessment of head injuries in motorcyclists involved in traffic accidents: A prospective, observational study

Clinical assessment of head injuries in motorcyclists involved in traffic accidents: A prospective, observational study

Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department

Investigação da presença de lesões traumáticas em segmento cefálico em motociclistas vítimas de acidentes de tráfego: Estudo observacional prospectivo

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