BACKGROUND: The effect of pre-injury antiplatelet treatment in the risk of intracranial lesions in subjects after mild head injury (Glasgow Coma Scale (GCS) 14-15) is uncertain. METHODS: The potential risk was determined, considering its increasing use in guidelines on cardiovascular disease prevention, and ageing of the trauma population in Europe. PATIENTS: The interaction of antiplatelet therapy with the prediction variables of main decision aids was analysed in 14,288 consecutive adolescent and adult subjects with mild head injury. MEASUREMENTS: Any intracranial lesion at CT scan was selected as an outcome measure in a multivariable logistic regression analysis. RESULTS: Intracranial lesions were demonstrated in 880 cases (6.2%), with an unfavourable outcome at 6 months in 86 (0.6%). Antiplatelet drugs were recorded in 10% of the entire cohort (24.7% in the group over 65 years). They increased the risk of intracranial lesions in the univariate analysis (OR 2.6; 95% CI 2.2 to 3.1), interacting with age in the multivariate analysis (antiplatelet OR 2.7 (1.9 to 3.7); age ≥75 years 1.4 (1.0 to 1.9)). The inclusion of these two variables with those included in previous decision aids for CT scanning (GCS, neurodeficit, post-traumatic seizures, suspected skull fracture, vomiting, loss of consciousness, coagulopathy) predicted intracranial lesions with a sensitivity of 99.7% (95% CI 98.9 to 99.8) and a specificity of 54.0% (95% CI 53.1 to 54.8), with a CT ordering rate of 49.3% (undetermined events 0.2:1000). INTERPRETATION: Antiplatelet drugs need to be considered in future prediction models on mild head injury, considering their increasing use and progressive ageing of the trauma population.
BACKGROUND: The effect of pre-injury antiplatelet treatment in the risk of intracranial lesions in subjects after mild head injury (Glasgow Coma Scale (GCS) 14-15) is uncertain. METHODS: The potential risk was determined, considering its increasing use in guidelines on cardiovascular disease prevention, and ageing of the trauma population in Europe. PATIENTS: The interaction of antiplatelet therapy with the prediction variables of main decision aids was analysed in 14,288 consecutive adolescent and adult subjects with mild head injury. MEASUREMENTS: Any intracranial lesion at CT scan was selected as an outcome measure in a multivariable logistic regression analysis. RESULTS:Intracranial lesions were demonstrated in 880 cases (6.2%), with an unfavourable outcome at 6 months in 86 (0.6%). Antiplatelet drugs were recorded in 10% of the entire cohort (24.7% in the group over 65 years). They increased the risk of intracranial lesions in the univariate analysis (OR 2.6; 95% CI 2.2 to 3.1), interacting with age in the multivariate analysis (antiplatelet OR 2.7 (1.9 to 3.7); age ≥75 years 1.4 (1.0 to 1.9)). The inclusion of these two variables with those included in previous decision aids for CT scanning (GCS, neurodeficit, post-traumatic seizures, suspected skull fracture, vomiting, loss of consciousness, coagulopathy) predicted intracranial lesions with a sensitivity of 99.7% (95% CI 98.9 to 99.8) and a specificity of 54.0% (95% CI 53.1 to 54.8), with a CT ordering rate of 49.3% (undetermined events 0.2:1000). INTERPRETATION: Antiplatelet drugs need to be considered in future prediction models on mild head injury, considering their increasing use and progressive ageing of the trauma population.
Authors: Randall Z Allison; Kazuma Nakagawa; Michael Hayashi; Daniel J Donovan; Matthew A Koenig Journal: Neurocrit Care Date: 2017-02 Impact factor: 3.210
Authors: M J Daley; Z Enright; J Nguyen; S Ali; A Clark; J D Aydelotte; P G Teixeira; T B Coopwood; C V R Brown Journal: Eur J Trauma Emerg Surg Date: 2016-02-18 Impact factor: 3.693
Authors: Rolf Rossaint; Bertil Bouillon; Vladimir Cerny; Timothy J Coats; Jacques Duranteau; Enrique Fernández-Mondéjar; Daniela Filipescu; Beverley J Hunt; Radko Komadina; Giuseppe Nardi; Edmund A M Neugebauer; Yves Ozier; Louis Riddez; Arthur Schultz; Jean-Louis Vincent; Donat R Spahn Journal: Crit Care Date: 2016-04-12 Impact factor: 9.097