Incidence of delayed intracranial hemorrhage in older patients after blunt head trauma

for the Sacramento County Prehospital Research Consortium

Research output: Contribution to journalArticle

9 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)570-575
Number of pages6
JournalJAMA Surgery
Volume153
Issue number6
DOIs
StatePublished - Jun 1 2018

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Intracranial Hemorrhages
Craniocerebral Trauma
Traumatic Intracranial Hemorrhage
Incidence
Anticoagulants
Lost to Follow-Up
Emergency Medical Services
Warfarin
Telephone
Multicenter Studies
Observational Studies
Hospital Emergency Service
Cohort Studies
Tomography
Observation
Outcome Assessment (Health Care)
Guidelines

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 journalArticle

for the Sacramento County Prehospital Research Consortium 2018, 'Incidence of delayed intracranial hemorrhage in older patients after blunt head trauma', JAMA Surgery, vol. 153, no. 6, pp. 570-575. https://doi.org/10.1001/jamasurg.2017.6159
for the Sacramento County Prehospital Research Consortium. / Incidence of delayed intracranial hemorrhage in older patients after blunt head trauma. In: JAMA Surgery. 2018 ; Vol. 153, No. 6. pp. 570-575.
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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.",
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AU - Nishijima, Daniel

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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.

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