دورية أكاديمية
Repeat computed tomography head scan is not indicated in trauma patients taking novel anticoagulation: A multicenter study.
| العنوان: | Repeat computed tomography head scan is not indicated in trauma patients taking novel anticoagulation: A multicenter study. |
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| المؤلفون: | Cohan, Caitlin M, Beattie, Genna, Bowman, Jessica A, Galante, Joseph M, Kwok, Amy M, Dirks, Rachel C, Kornblith, Lucy Z, Plevin, Rebecca, Browder, Timothy D, Victorino, Gregory P |
| المصدر: | The journal of trauma and acute care surgery, vol 89, iss 2 |
| بيانات النشر: | eScholarship, University of California |
| سنة النشر: | 2020 |
| المجموعة: | University of California: eScholarship |
| مصطلحات موضوعية: | Humans, Intracranial Hemorrhages, Craniocerebral Trauma, Warfarin, Anticoagulants, Tomography, X-Ray Computed, Prognosis, Administration, Oral, Incidence, Risk Factors, Retrospective Studies, Unnecessary Procedures, California, Practice Patterns, Physicians', Biomedical Imaging, Hematology, Stroke, Clinical Trials and Supportive Activities, Clinical Research, Physical Injury - Accidents and Adverse Effects, Brain Disorders, Injuries and accidents, Novel anticoagulants, trauma, intracranial hemorrhage, Cardiorespiratory Medicine and Haematology, Clinical Sciences |
| جغرافية الموضوع: | 301 - 310 |
| الوصف: | BackgroundThe number of trauma patients on prehospital novel oral anticoagulants (NOACs) is increasing. After an initial negative computed tomography of the head (CTH), practice patterns are variable for obtaining repeat CTH to evaluate for delayed intracranial hemorrhage (ICH-d). However, the risks and outcomes of ICH-d for patients on NOACs are unclear. We hypothesized that, for these patients, the incidence of ICH-d is low, similar to that of warfarin, and when it occurs, it does not result in clinically significant worse outcomes.MethodsFive level 1 trauma centers in Northern California participated in a retrospective review of anticoagulated trauma patients. Patients were included if their initial CTH was negative. Primary outcomes were incidence of ICH-d, neurosurgical intervention, and death. Patient factors associated with the outcome of ICH-d were determined by multivariable regression.ResultsFrom 2016 to 2018, 777 patients met the inclusion criteria (NOAC, n = 346; warfarin, n = 431), 54% of whom received a repeat CTH. Delayed intracranial hemorrhage incidence was 2.3% in the NOAC group and 4% in the warfarin group (p = 0.31). No NOAC patient with ICH-d required neurosurgical intervention or died because of their head injury. Two warfarin patients received neurosurgical intervention, and three died from their head injury. Head Abbreviated Injury Scale ≥3 was associated with increased odds of developing ICH-d (adjusted odds ratio, 32.70; p < 0.01).ConclusionThe incidence of ICH-d in patients taking NOAC is low. In this study, patients on NOACs who developed ICH-d after an initial negative CTH did not need neurosurgical intervention or die from their head injury. Repeat CTH in this patient population does not appear necessary.Level of evidencePrognostic/epidemiologic study, level III.Therapeutic, level IV. |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | application/pdf |
| اللغة: | unknown |
| العلاقة: | qt68t6j4hr; https://escholarship.org/uc/item/68t6j4hrTest; https://escholarship.org/content/qt68t6j4hr/qt68t6j4hr.pdfTest |
| DOI: | 10.1097/ta.0000000000002760 |
| الإتاحة: | https://doi.org/10.1097/ta.0000000000002760Test https://escholarship.org/uc/item/68t6j4hrTest https://escholarship.org/content/qt68t6j4hr/qt68t6j4hr.pdfTest |
| حقوق: | public |
| رقم الانضمام: | edsbas.20DC7E49 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1097/ta.0000000000002760 |
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