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Predictive factors of intracranial bleeding in head trauma patients receiving antiplatelet therapy admitted to an emergency department
Moustafa, F. Roubin, Jean Pereira, Bruno Barres, Alain Saint-Denis, Jennifer Perrier, Christophe Mondet, Marine Dutheil, Frederic Schmidt, Jeannot
Moustafa, F.
Roubin, Jean
Pereira, Bruno
Barres, Alain
Saint-Denis, Jennifer
Perrier, Christophe
Mondet, Marine
Dutheil, Frederic
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.
Keywords
Date
2018
Type
Journal article
Journal
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Book
Volume
26
Issue
1
Page Range
1-7
Article Number
ACU Department
Collections
Relation URI
Source URL
Event URL
Open Access Status
Open access
License
CC BY 4.0
File Access
Open