David Robinson1, Logan Pyle2, Brandon Foreman3, Laura B Ngwenya4, Opeolu Adeoye5, Daniel Woo6, Natalie Kreitzer7. 1. Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH, USA. Electronic address: Robin2dv@ucmail.uc.edu. 2. Department of Pulmonology and Critical Care, University of Pittsburgh Medical Center Hamot, PA, USA. Electronic address: pylelm@upmc.edu. 3. Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH, USA; Collaborative for Research on Acute Neurological Injuries, OH, USA. Electronic address: foremabo@ucmail.uc.edu. 4. Department of Neurosurgery, University of Cincinnati, OH, USA; Collaborative for Research on Acute Neurological Injuries, OH, USA. Electronic address: ngwenyla@ucmail.uc.edu. 5. Department of Neurosurgery, University of Cincinnati, OH, USA; Department of Emergency Medicine, University of Cincinnati, OH, USA. Electronic address: adeoyeo@ucmail.uc.edu. 6. Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH, USA. Electronic address: woodl@ucmail.uc.edu. 7. Department of Emergency Medicine, University of Cincinnati, OH, USA. Electronic address: kreitzne@ucmail.uc.edu.
Abstract
BACKGROUND: Antithrombotic-associated subdural hematomas (SDHs) are increasingly common, and the possibility of clinical deterioration in otherwise stable antithrombotic-associated SDH patients may prompt unnecessary admissions to intensive care units. It is unknown whether all antithrombotic regimens are equally associated with the need for critical care interventions. We sought to compare the frequency of critical care interventions and poor functional outcomes among three cohorts of noncomatose SDH patients: patients on no antithrombotics, patients on anticoagulants, and patients on antiplatelets alone. METHODS: We performed a retrospective cohort study on all noncomatose SDH patients (Glasgow Coma Scale > 12) presenting to an academic health system in 2018. The three groups of patients were compared in terms of clinical course and functional outcome. Multivariable logistic regression was used to determine predictors of need for critical care interventions and poor functional outcome at hospital discharge. RESULTS: There were 281 eligible patients presenting with SDHs in 2018, with 126 (45%) patients on no antithrombotics, 106 (38%) patients on antiplatelet medications alone, and 49 (17%) patients on anticoagulants. Significant predictors of critical care interventions were coagulopathy (OR 5.1, P < 0.001), presence of contusions (OR 3, P = 0.007), midline shift (OR 3.4, P = 0.002), and maximum SDH thickness (OR 2.4, P = 0.002). Significant predictors of poor functional outcome were age (OR 1.8, P < 0.001), admission Glasgow Coma Scale score (OR 0.3, P < 0.001), dementia history (OR 4.2, P = 0.001), and coagulopathy (OR 3.5, P = 0.02). Isolated antiplatelet use was not associated with either critical care interventions or functional outcome. CONCLUSION: Isolated antiplatelet use is not a significant predictor of need for critical care interventions or poor functional outcome among SDH patients and should not be used as a criterion for triage to the intensive care unit.
BACKGROUND: Antithrombotic-associated subdural hematomas (SDHs) are increasingly common, and the possibility of clinical deterioration in otherwise stable antithrombotic-associated SDH patients may prompt unnecessary admissions to intensive care units. It is unknown whether all antithrombotic regimens are equally associated with the need for critical care interventions. We sought to compare the frequency of critical care interventions and poor functional outcomes among three cohorts of noncomatose SDH patients: patients on no antithrombotics, patients on anticoagulants, and patients on antiplatelets alone. METHODS: We performed a retrospective cohort study on all noncomatose SDH patients (Glasgow Coma Scale > 12) presenting to an academic health system in 2018. The three groups of patients were compared in terms of clinical course and functional outcome. Multivariable logistic regression was used to determine predictors of need for critical care interventions and poor functional outcome at hospital discharge. RESULTS: There were 281 eligible patients presenting with SDHs in 2018, with 126 (45%) patients on no antithrombotics, 106 (38%) patients on antiplatelet medications alone, and 49 (17%) patients on anticoagulants. Significant predictors of critical care interventions were coagulopathy (OR 5.1, P < 0.001), presence of contusions (OR 3, P = 0.007), midline shift (OR 3.4, P = 0.002), and maximum SDH thickness (OR 2.4, P = 0.002). Significant predictors of poor functional outcome were age (OR 1.8, P < 0.001), admission Glasgow Coma Scale score (OR 0.3, P < 0.001), dementia history (OR 4.2, P = 0.001), and coagulopathy (OR 3.5, P = 0.02). Isolated antiplatelet use was not associated with either critical care interventions or functional outcome. CONCLUSION: Isolated antiplatelet use is not a significant predictor of need for critical care interventions or poor functional outcome among SDH patients and should not be used as a criterion for triage to the intensive care unit.
Authors: Jonathan J Ratcliff; Opeolu Adeoye; Christopher J Lindsell; Kimberly W Hart; Arthur Pancioli; Jason T McMullan; John K Yue; Daniel K Nishijima; Wayne A Gordon; Alex B Valadka; David O Okonkwo; Hester F Lingsma; Andrew I R Maas; Geoffrey T Manley Journal: Am J Emerg Med Date: 2014-04-13 Impact factor: 2.469
Authors: François Mathieu; Helge Güting; Benjamin Gravesteijn; Miguel Monteiro; Ben Glocker; Evgenios N Kornaropoulos; Konstantinos Kamnistas; Claudia S Robertson; Harvey Levin; Daniel P Whitehouse; Tilak Das; Hester F Lingsma; Marc Maegele; Virginia F J Newcombe; David K Menon Journal: J Neurotrauma Date: 2020-06-03 Impact factor: 5.269