Abstract
IMPORTANCE Current guidelines conflict on the management of older adults who have blunt head trauma taking anticoagulant and antiplatelet medications. This is partially due to the limited data comparing patients who are taking these medications with those who are not. OBJECTIVE To investigate the incidence of delayed traumatic intracranial hemorrhage in older adults with head trauma, including those taking anticoagulant and antiplatelet medications. DESIGN, SETTING, AND PARTICIPANTS This prospective observational cohort study included patients 55 years and older who had blunt head trauma and were transported via emergency medical services between August 1, 2015, and September 30, 2016. The setting was a multicenter study conducted at 11 hospitals in northern California. Patients were excluded if they had traumatic intracranial hemorrhage on the initial cranial computed tomographic scan, did not have a cranial computed tomographic scan performed at the initial emergency department visit, refused consent for a follow-up telephone call, or did not have reliable means of follow-up. MAIN OUTCOME AND MEASURE The primary outcome of this study was the incidence of delayed traumatic intracranial hemorrhage within 14 days of injury. RESULTS Among 859 patients enrolled in the study, the median age was 75 years (interquartile range, 64-85 years), and 389 (45.3%) were male. A total of 343 patients (39.9%) were taking an anticoagulant or antiplatelet medication. Three patients (0.3%; 95% CI, 0.1%-1.0%) had a delayed traumatic intracranial hemorrhage. Of the 3 patients, 1 of 75 patients (1.3%; 95% CI, 0.0%-7.2%) who were taking warfarin sodium alone and 2 of 516 patients (0.4%; 95% CI, 0.1%-1.4%) who were not taking any anticoagulant or antiplatelet medication had a delayed traumatic intracranial hemorrhage. Thirty-nine patients (4.5%; 95% CI, 3.2%-6.2%) were lost to follow-up. CONCLUSIONS AND RELEVANCE Overall, the incidence of delayed intracranial hemorrhage in older adults who have blunt head trauma is low, including patients taking an anticoagulant or antiplatelet medication. These findings suggest that routine observation and serial cranial computed tomography may not be necessary in these patients.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 570-575 |
| Number of pages | 6 |
| Journal | JAMA Surgery |
| Volume | 153 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 1 2018 |
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ASJC Scopus subject areas
- Surgery
Cite this
Incidence of delayed intracranial hemorrhage in older patients after blunt head trauma. / for the Sacramento County Prehospital Research Consortium.
In: JAMA Surgery, Vol. 153, No. 6, 01.06.2018, p. 570-575.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Incidence of delayed intracranial hemorrhage in older patients after blunt head trauma
AU - for the Sacramento County Prehospital Research Consortium
AU - Chenoweth, James
AU - Gaona, Samuel D.
AU - Faul, Mark
AU - Holmes Jr, James F
AU - Nishijima, Daniel
PY - 2018/6/1
Y1 - 2018/6/1
N2 - IMPORTANCE Current guidelines conflict on the management of older adults who have blunt head trauma taking anticoagulant and antiplatelet medications. This is partially due to the limited data comparing patients who are taking these medications with those who are not. OBJECTIVE To investigate the incidence of delayed traumatic intracranial hemorrhage in older adults with head trauma, including those taking anticoagulant and antiplatelet medications. DESIGN, SETTING, AND PARTICIPANTS This prospective observational cohort study included patients 55 years and older who had blunt head trauma and were transported via emergency medical services between August 1, 2015, and September 30, 2016. The setting was a multicenter study conducted at 11 hospitals in northern California. Patients were excluded if they had traumatic intracranial hemorrhage on the initial cranial computed tomographic scan, did not have a cranial computed tomographic scan performed at the initial emergency department visit, refused consent for a follow-up telephone call, or did not have reliable means of follow-up. MAIN OUTCOME AND MEASURE The primary outcome of this study was the incidence of delayed traumatic intracranial hemorrhage within 14 days of injury. RESULTS Among 859 patients enrolled in the study, the median age was 75 years (interquartile range, 64-85 years), and 389 (45.3%) were male. A total of 343 patients (39.9%) were taking an anticoagulant or antiplatelet medication. Three patients (0.3%; 95% CI, 0.1%-1.0%) had a delayed traumatic intracranial hemorrhage. Of the 3 patients, 1 of 75 patients (1.3%; 95% CI, 0.0%-7.2%) who were taking warfarin sodium alone and 2 of 516 patients (0.4%; 95% CI, 0.1%-1.4%) who were not taking any anticoagulant or antiplatelet medication had a delayed traumatic intracranial hemorrhage. Thirty-nine patients (4.5%; 95% CI, 3.2%-6.2%) were lost to follow-up. CONCLUSIONS AND RELEVANCE Overall, the incidence of delayed intracranial hemorrhage in older adults who have blunt head trauma is low, including patients taking an anticoagulant or antiplatelet medication. These findings suggest that routine observation and serial cranial computed tomography may not be necessary in these patients.
AB - IMPORTANCE Current guidelines conflict on the management of older adults who have blunt head trauma taking anticoagulant and antiplatelet medications. This is partially due to the limited data comparing patients who are taking these medications with those who are not. OBJECTIVE To investigate the incidence of delayed traumatic intracranial hemorrhage in older adults with head trauma, including those taking anticoagulant and antiplatelet medications. DESIGN, SETTING, AND PARTICIPANTS This prospective observational cohort study included patients 55 years and older who had blunt head trauma and were transported via emergency medical services between August 1, 2015, and September 30, 2016. The setting was a multicenter study conducted at 11 hospitals in northern California. Patients were excluded if they had traumatic intracranial hemorrhage on the initial cranial computed tomographic scan, did not have a cranial computed tomographic scan performed at the initial emergency department visit, refused consent for a follow-up telephone call, or did not have reliable means of follow-up. MAIN OUTCOME AND MEASURE The primary outcome of this study was the incidence of delayed traumatic intracranial hemorrhage within 14 days of injury. RESULTS Among 859 patients enrolled in the study, the median age was 75 years (interquartile range, 64-85 years), and 389 (45.3%) were male. A total of 343 patients (39.9%) were taking an anticoagulant or antiplatelet medication. Three patients (0.3%; 95% CI, 0.1%-1.0%) had a delayed traumatic intracranial hemorrhage. Of the 3 patients, 1 of 75 patients (1.3%; 95% CI, 0.0%-7.2%) who were taking warfarin sodium alone and 2 of 516 patients (0.4%; 95% CI, 0.1%-1.4%) who were not taking any anticoagulant or antiplatelet medication had a delayed traumatic intracranial hemorrhage. Thirty-nine patients (4.5%; 95% CI, 3.2%-6.2%) were lost to follow-up. CONCLUSIONS AND RELEVANCE Overall, the incidence of delayed intracranial hemorrhage in older adults who have blunt head trauma is low, including patients taking an anticoagulant or antiplatelet medication. These findings suggest that routine observation and serial cranial computed tomography may not be necessary in these patients.
UR - http://www.scopus.com/inward/record.url?scp=85049189741&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85049189741&partnerID=8YFLogxK
U2 - 10.1001/jamasurg.2017.6159
DO - 10.1001/jamasurg.2017.6159
M3 - Article
C2 - 29450470
AN - SCOPUS:85049189741
VL - 153
SP - 570
EP - 575
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 6
ER -