Predictive factors of intracranial bleeding in head trauma patients receiving antiplatelet therapy admitted to an emergency department

Journal article


Moustafa, F., Roubin, Jean, Pereira, Bruno, Barres, Alain, Saint-Denis, Jennifer, Perrier, Christophe, Mondet, Marine, Dutheil, Frederic and Schmidt, Jeannot. (2018). Predictive factors of intracranial bleeding in head trauma patients receiving antiplatelet therapy admitted to an emergency department. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 26(1), pp. 1 - 7. https://doi.org/10.1186/s13049-018-0515-0
AuthorsMoustafa, F., Roubin, Jean, Pereira, Bruno, Barres, Alain, Saint-Denis, Jennifer, Perrier, Christophe, Mondet, Marine, Dutheil, Frederic and Schmidt, Jeannot
Abstract

Background In head trauma cases involving antiplatelet agent treatment, the French Society of Emergency Medicine recommends performing computed tomography (CT) scans to detect brain lesions, 90% of which are normal. The value of CT is still debatable given the scarce number of studies and controversial results. Methods We used the RATED registry (Registry of patient with Antithrombotic agents admitted to an Emergency Department, NCT02706080) to assess factors of cerebral bleeding related to antiplatelet agents following head trauma. Results From January 2014 to December 2015, 993 patients receiving antiplatelet agents were recruited, 293 (29.5%) of whom underwent CT scans for brain trauma. Intracranial bleeding was found in 26 (8.9%). Multivariate analysis revealed these patients more likely to have a history of severe hemorrhage (odds ratio [OR]: 8.47, 95% confidence interval [CI]: 1.56–45.82), dual antiplatelet therapy (OR: 6.46, 95%CI:1.46–28.44), headache or vomiting (OR: 4.27, 95%CI: 1.44–2.60), and abnormal Glasgow coma scale (OR: 8.60; 95%CI: 2.85–25.99) compared to those without intracranial bleeding. The predictive model derived from these variables achieved 98.9% specificity and a negative predictive value of 92%. The area under the ROC curve (AUROC) was 0.85 (95%CI: 0.77–0.93). Conclusions Our study demonstrated that the absence of history of severe hemorrhage, dual antiplatelet therapy, headache or vomiting, and abnormal Glasgow coma scale score appears to predict normal CT scan following traumatic brain injury in patients taking antiplatelets. This finding requires confirmation by prospective studies. Trial registration ClinicalTrials.gov number: NCT02706080.

Year2018
JournalScandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Journal citation26 (1), pp. 1 - 7
PublisherBiomed Central Ltd
ISSN1757-7241
Digital Object Identifier (DOI)https://doi.org/10.1186/s13049-018-0515-0
Scopus EID2-s2.0-85048955586
Open accessOpen access
Page range1 - 7
Research GroupSports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre
Publisher's version
License
Place of publicationUnited Kingdom
EditorsK. G. Bache
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Dutheil, Frederic, Walther, Guillame, Chapier, Robert, Mnatzaganian, George, Lesourd, Bruno, Naughton, Geraldine, Verney, Julien, Fogli, Anne, Sapin, Vincent, Duclos, Martine, Vinet, Agnes, Obert, Philippe, Courteix, Daniel and Lac, Gerard. (2014). Atherogenic subfractions of lipoproteins in the treatment of metabolic syndrome by physical activity and diet - the RESOLVE trial. Lipids in Health and Disease. 13(1). https://doi.org/10.1186/1476-511X-13-112
Comparison of the ultra-low-dose Veo algorithm with the gold standard filtered back projection for detecting pulmonary asbestos-related conditions : A clinical observational study
Tekath, Marielle, Dutheil, Frederic, Bellini, Romain, Roche, Antoine, Pereira, Bruno, Naughton, Geraldine, Chamoux, Alain and Michel, Jean-Luc. (2014). Comparison of the ultra-low-dose Veo algorithm with the gold standard filtered back projection for detecting pulmonary asbestos-related conditions : A clinical observational study. BMJ Open. 4(5), pp. 1 - 8. https://doi.org/10.1136/bmjopen-2014-004980
Right ventricle free wall mechanics in metabolic syndrome without type-2 diabetes: Effects of a 3-month lifestyle intervention program
Serrano-Ferrer, Juan, Walther, Guillaume, Crendal, Edward, Vinet, Agnes, Dutheil, Frederic, Naughton, Geraldine A., Lesourd, Bruno, Chapier, Robert, Courteix, Daniel and Obert, Philippe. (2014). Right ventricle free wall mechanics in metabolic syndrome without type-2 diabetes: Effects of a 3-month lifestyle intervention program. Cardiovascular Diabetology. 13(1), pp. 1 - 11. https://doi.org/10.1186/s12933-014-0116-9
Atherogenic subfractions of lipoproteins in the treatment of metabolic syndrome by physical activity and diet : the RESOLVE trial
Dutheil, Frederic, Walther, Guillaume, Chapier, Robert, Mnatzaganian, George, Lesourd, Bruno, Naughton, Geraldine, Verney, Julien, Fogli, Anne, Sapin, Vincent and Duclose, Martine. (2014). Atherogenic subfractions of lipoproteins in the treatment of metabolic syndrome by physical activity and diet : the RESOLVE trial. Lipids in Health and Disease. 13(112), pp. 1 - 9. https://doi.org/10.1186/1476-511X-13-112
Myocardial deformation and twist mechanics in adults with metabolic syndrome : Impact of cumulative metabolic burden
Crendal, Edward, Walther, Guillaume, Vinet, Agnes, Dutheil, Frederic, Naughton, Geraldine, Lesourd, Bruno, Chapier, Robert, Rupp, Thomas, Courteix, Daniel and Obert, Philippe. (2013). Myocardial deformation and twist mechanics in adults with metabolic syndrome : Impact of cumulative metabolic burden. Obesity: a resourch journal. https://doi.org/10.1002/oby.20537
Urinary Interleukin-8 is a biomarker of stress in emergency physicians, especially with advancing age: The JOBSTRESS* randomized trial
Dutheil, Frederic, Trousselard, Marion, Perrier, Christophe, Lac, Gerard, Chamoux, Alain, Duclos, Martine, Naughton, Geraldine, Mnatzaganian, George and Schmidt, Jeannot. (2013). Urinary Interleukin-8 is a biomarker of stress in emergency physicians, especially with advancing age: The JOBSTRESS* randomized trial. PLoS ONE. 8(8), pp. 1 - 7. https://doi.org/10.1371/journal.pone.0071658
Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome : the RESOLVE* randomized trial
Dutheil, Frederic, Lac, Gerard, Lesourd, Bruno, Chapier, Robert, Walther, Guillaume, Vinet, Agnes, Sapin, Vincent, Verney, Julien, Ouchchane, Lemlih and Duclos, Martine. (2013). Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome : the RESOLVE* randomized trial. International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2013.05.012
The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation : a cross-sectional study 15 years after retirement
Lopez, Vincent, Chamoux, Alain, Tempier, Marion, Thiel, Helene, Ughetto, Sylvie, Trousselard, Marion, Naughton, Geraldine and Dutheil, Frederic. (2013). The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation : a cross-sectional study 15 years after retirement. BMJ Open. https://doi.org/10.1136/bmjopen-2013-002785
Treatment of Metabolic syndrome by combination of physical activity and diet needs an optimal protein intake: a randomized controlled trial
Dutheil, Frederic, Lac, Gerard, Courteix, Daniel, Dore, Eric, Chapier, Robert, Roszyk, Laurence, Sapin, Vincent and Lesourd, Bruno. (2012). Treatment of Metabolic syndrome by combination of physical activity and diet needs an optimal protein intake: a randomized controlled trial. Nutrition Journal. 11(1). https://doi.org/10.1186/1475-2891-11-72