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. 2019 Oct;45(5):901-907.
doi: 10.1007/s00068-018-0941-8. Epub 2018 Mar 17.

Management of mild traumatic brain injury-trauma energy level and medical history as possible predictors for intracranial hemorrhage

Tomas Vedin  1 , Sebastian Svensson  2 , Marcus Edelhamre  2 , Mathias Karlsson  3 , Mikael Bergenheim  4 , Per-Anders Larsson  2
Affiliations

Management of mild traumatic brain injury-trauma energy level and medical history as possible predictors for intracranial hemorrhage

Tomas Vedin et al. Eur J Trauma Emerg Surg. 2019 Oct.

Abstract

Purpose: Head trauma is common in the emergency department. Identifying the few patients with serious injuries is time consuming and leads to many computerized tomographies (CTs). Reducing the number of CTs would reduce cost and radiation. The aim of this study was to evaluate the characteristics of adults with head trauma over a 1-year period to identify clinical features predicting intracranial hemorrhage.

Methods: Medical record data have been collected retrospectively in adult patients with traumatic brain injury. A total of 1638 patients over a period of 384 days were reviewed, and 33 parameters were extracted. Patients with high-energy multitrauma managed with ATLS™ were excluded. The analysis was done with emphasis on patient history, clinical findings, and epidemiological traits. Logistic regression and descriptive statistics were applied.

Results: Median age was 58 years (18-101, IQR 35-77). High age, minor head injury, new neurological deficits, and low trauma energy level correlated with intracranial hemorrhage. Patients younger than 59 years, without anticoagulation or antiplatelet therapy who suffered low-energy trauma, had no intracranial hemorrhages. The hemorrhage frequency in the entire cohort was 4.3% (70/1638). In subgroup taking anticoagulants, the frequency of intracranial hemorrhage was 8.6% (10/116), and in the platelet-inhibitor subgroup, it was 11.8% (20/169).

Conclusion: This study demonstrates that patients younger than 59 years with low-energy head trauma, who were not on anticoagulants or platelet inhibitors could possibly be discharged based on patient history. Maybe, there is no need for as extensive medical examination as currently recommended. These findings merit further studies.

Keywords: Brain injuries; Epidemiology; Intracranial hemorrhage; Practice guidelines as topic; S100B Calcium Binding Protein Beta Subunit; Traumatic.

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Conflict of interest statement

Authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Age distribution in patients with head trauma
See this image and copyright information in PMC

References

    1. Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, McKnight RD, Verbeek R, Brison R, Cass D, Eisenhauer ME, Greenberg G, Worthington J. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357:1391–1396. doi: 10.1016/S0140-6736(00)04561-X. - DOI - PubMed
    1. Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, Berrington de Gonzalez A, Miglioretti DL. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;169:2078–2086. doi: 10.1001/archinternmed.2009.427. - DOI - PMC - PubMed
    1. Brenner DJ. Should we be concerned about the rapid increase in CT usage? Rev Environ Health. 2010;25:63–68. doi: 10.1515/REVEH.2010.25.1.63. - DOI - PubMed
    1. Webster NJ, Moore N, Stewart F. Reducing unnecessary head computed tomography in mild traumatic brain injury. Adv Emerg Nurs J. 2017;39:300–308. doi: 10.1097/TME.0000000000000169. - DOI - PubMed
    1. Goldberg J, McClaine RJ, Cook B, Garcia VF, Brown RL, Crone K, Falcone RA. Use of a mild traumatic brain injury guideline to reduce inpatient hospital imaging and charges. J Pediatr Surg. 2011;46:1777–1783. doi: 10.1016/j.jpedsurg.2011.02.052. - DOI - PubMed

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