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. 2023 Sep 4;16(1):54.
doi: 10.1186/s12245-023-00530-z.

Delayed intracranial hemorrhage after head trauma seems rare and rarely needs intervention-even in antiplatelet or anticoagulation therapy

Henrik Bergenfeldt  1 , Jakob Lundager Forberg  2 , Riikka Lehtinen  2 , Ebba Anefjäll  2 , Tomas Vedin  3
Affiliations

Delayed intracranial hemorrhage after head trauma seems rare and rarely needs intervention-even in antiplatelet or anticoagulation therapy

Henrik Bergenfeldt et al. Int J Emerg Med. .

Abstract

Background: Traumatic brain injury causes morbidity, mortality, and at least 2,500,000 yearly emergency department visits in the USA. Computerized tomography of the head is the gold standard to detect traumatic intracranial hemorrhage. Some are not diagnosed at the first scan, and they are denoted "delayed intracranial hemorrhages. " To detect these delayed hemorrhages, current guidelines for head trauma recommend observation and/or rescanning for patients on anticoagulation therapy but not for patients on antiplatelet therapy. The aim of this study was to investigate the prevalence and need for interventions of delayed intracranial hemorrhage after head trauma.

Methods: The study was a retrospective review of medical records of adult patients with isolated head trauma presenting at Helsingborg General Hospital between January 1, 2020, and December 31, 2020. Univariate statistical analyses were performed.

Results: In total, 1627 patients were included and four (0.25%, 95% confidence interval 0.06-0.60%) patients had delayed intracranial hemorrhage. One of these patients was diagnosed within 24 h and three within 2-30 days. The patient was diagnosed within 24 h, and one of the patients diagnosed within 2-30 days was on antiplatelet therapy. None of these four patients was prescribed anticoagulation therapy, and no intensive care, no neurosurgical operations, or deaths were recorded.

Conclusion: Traumatic delayed intracranial hemorrhage is rare and consequences mild and antiplatelet and anticoagulation therapy might confer similar risk. Because serious complications appear rare, observing, and/or rescanning all patients with either of these medications can be debated. Risk stratification of these patients might have the potential to identify the patients at risk while safely reducing observation times and rescanning.

Keywords: Brain injuries; MESH; Traumatic anticoagulant tomography; Traumatic intracranial hemorrhages; X-ray computed.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Inclusion process. This shows inclusion and exclusion criteria, the number of patients that were excluded in each step, and the number of patients with different types of traumatic intracranial hemorrhage
See this image and copyright information in PMC

References

    1. Vedin T, Svensson S, Edelhamre M, Karlsson M, Bergenheim M, Larsson PA. Management of mild traumatic brain injury-trauma energy level and medical history as possible predictors for intracranial hemorrhage. Eur J Trauma Emerg Surg. 2019;45:901–907. doi: 10.1007/s00068-018-0941-8. - DOI - PMC - PubMed
    1. Leach P, Childs C, Evans J, Johnston N, Protheroe R, King A. Transfer times for patients with extradural and subdural haematomas to neurosurgery in Greater Manchester. Br J Neurosurg. 2007;21:11–15. doi: 10.1080/02688690701210562. - DOI - PubMed
    1. Nakahara S, Matsuoka T, Ueno M, Mizushima Y, Ichikawa M, Yokota J, et al. Predictive factors for undertriage among severe blunt trauma patients: what enables them to slip through an established trauma triage protocol. J Trauma. 2010;68:1044–1051. - PubMed
    1. Aygun N, Masaryk TJ. Diagnostic imaging for intracerebral hemorrhage. Neurosurg Clin N Am. 2002;13(313–34):vi. - PubMed
    1. Brazinova A, Rehorcikova V, Taylor MS, Buckova V, Majdan M, Psota M, et al. Epidemiology of Traumatic Brain Injury in Europe: A Living Systematic Review. J Neurotrauma. 2021;38:1411–1440. doi: 10.1089/neu.2015.4126. - DOI - PMC - PubMed

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