Findings on Repeat Posttraumatic Brain Computed Tomography Scans in Older Patients With Minimal Head Trauma and the Impact of Existing Antithrombotic Use - 20/02/23
the Delayed TBI Hemorrhage Research Group†
Abstract |
Study objective |
Evaluate the utility of routine rescanning of older, mild head trauma patients with an initial negative brain computed tomography (CT), who is on a preinjury antithrombotic (AT) agent by assessing the rate of delayed intracranial hemorrhage (dICH), need for surgery, and attributable mortality.
Methods |
Participating centers were trained and provided data collection instruments per institutional review board-approved protocols. Data were obtained from manual chart review and electronic medical record download. Adults ≥55 years seen at Level I/II Trauma Centers, between 2017 and 2019 with suspected head trauma, Glasgow Coma Scale 14 to 15, negative initial brain CT, and no other Abbreviated Injury Scale injuries >2 were identified, grouped by preinjury AT therapy (AT- or AT+) and compared on dICH rate, need for operative neurosurgical intervention, and attributable mortality using univariate analysis (α=.05).
Results |
A total of 2,950 patients from 24 centers were enrolled; 280 (9.5%) had a repeat brain CT. In those rescanned, the dICH rate was 15/126 (11.9%) for AT- and 6/154 (3.9%) in AT+. Assuming nonrescanned patients did not suffer clinically meaningful dICH, the dICH rate would be 15/2001 (0.7%) for AT- and 6/949 (0.6%) for AT+. No surgical operations were done for dICH. All-cause mortality was 9/2950 (0.3%) and attributable mortality was 1/2950 (0.03%). The attributable death was an AT+, dICH patient whose family declined intervention.
Conclusion |
In older patients with an initial Glasgow Coma Scale of 14 to 15 and a negative initial brain CT scan, the dICH rate is low (<1%) and of minimal clinical consequence, regardless of AT use. In addition, no patient had operative neurosurgical intervention. Therefore, routine rescanning is not supported based on the results of this study.
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| Please see page 365 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Timothy F. Platts-Mills, MD, MSc. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: SF, SMF, DDW, RJW, and JMG conceived the study and designed the trial. SB, PJO, JDL, WCS, DLH, and RWG contributed significantly to the revision of the final design of the trial. DDW, RJW, and NYW supervised the trial's conduct and data collection. YS and NYW managed the data, including quality control. SF, SMF, MJL, and TMD undertook the recruitment of participating centers. SF, SB, PJO, JDL, WCS, DLH, RWG, and Delayed Hemorrhage TBI Research Group abstracted charts, including quality control, and provided substantial data for the study. YS provided statistical consultation and analyzed the data. SB, SMF, RJW, DDW, JMG, and YS drafted the manuscript, and all masthead authors contributed substantially to its revision. All authors certified that they contributed to the design, data acquisition, data analysis/interpretation, and drafting/revising of the manuscript. The authors have approved the version to be published. SF and SMF take responsibility for the paper as a whole. |
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| Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. |
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| This research was supported (in whole or part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. However, the views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities. |
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Vol 81 - N° 3
P. 364-374 - mars 2023 Retour au numéro
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