Low Incidence of Delayed Intracranial Hemorrhage in Geriatric Emergency Department Patients on Preinjury Anticoagulation Presenting with Blunt Head Trauma

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2024-12-01 DOI:10.1016/j.jemermed.2024.06.002

Richard D. Shih MD , Scott M. Alter MD , Joshua J. Solano MD , Gabriella Engstrom PhD, RN , Mike Wells MBBCh, PhD , Lisa M. Clayton DO , Patrick G. Hughes DO , Lara Nicole Goldstein MBBCh, PhD , Faris K. Azar MD , Joseph G. Ouslander MD

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引用次数: 0

Abstract

Background

Delayed intracranial hemorrhage (ICH) after head injury in older patients taking anticoagulants has been reported to be as high as 7.2%. Other studies suggest much lower rates. Its incidence and clinical management are controversial, with some recommending observation and repeat head imaging at 24 h.

Objective

Our study aims to assess the incidence of delayed ICH in geriatric Emergency Department (ED) head trauma patients prescribed preinjury anticoagulants.

Methods

We performed a prospective cohort study conducted at two hospital EDs from August 2019 to July 2020. All patients aged 65 years or older with acute head injury were eligible for enrollment. We conducted telephone follow-up at 14 and 60 days, and a chart review at 90 days. The primary study outcome was incidence of delayed ICH, which was defined as an initial negative head computed tomography scan followed by subsequent ICH believed to be caused by the initial traumatic event. We compared the rates of delayed ICH between patient cohorts based on anticoagulant use.

Results

There were 3425 patients enrolled: 2300 (67.2%) were not on an anticoagulant, 249 (7%) were on preinjury warfarin, 780 (22.7%) were on a direct-acting oral anticoagulant, and 96 (2.8%) were on enoxaparin or heparin. The median age was 82 years (interquartile range 65-107), the majority were female (55.2%), and almost all were Caucasian (84.3%). An acute ICH was identified in 229 of 3425 (6.7%, 95% confidence interval 6–8%) and delayed ICH in 13 (0.4%, 95% confidence interval 0.2–0.6%). There were no differences in rates of delayed ICH between those who had been prescribed anticoagulants vs. those who had not (p = 0.45).

Conclusions

The incidence of delayed ICH is very low in older ED head trauma patients on prescribed pre-injury anticoagulants. Our data have important clinical implications for the management of blunt head trauma among older ED patients on anticoagulants.

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头部钝性外伤的老年急诊患者在受伤前接受抗凝治疗，延迟性颅内出血的发生率较低

据报道，服用抗凝剂的老年患者颅脑损伤后迟发性颅内出血（ICH）的发生率高达7.2%。其他研究表明，这一比例要低得多。其发病率和临床处理存在争议，一些人建议在24小时进行观察和重复头部成像。目的本研究旨在评估老年急诊科（ED）头部创伤患者在伤前抗凝治疗后迟发性脑出血的发病率。方法2019年8月至2020年7月在两家医院急诊科进行前瞻性队列研究。所有年龄在65岁及以上的急性颅脑损伤患者均符合入组条件。我们分别在第14天和第60天进行电话随访，并在第90天进行图表回顾。主要研究结果是迟发性脑出血的发生率，迟发性脑出血被定义为最初的头部计算机断层扫描呈阴性，随后被认为是由最初的创伤事件引起的脑出血。我们比较了基于抗凝剂使用的患者队列之间延迟性脑出血的发生率。结果共纳入3425例患者，其中2300例（67.2%）未使用抗凝药物，249例（7%）使用损伤前华法林，780例（22.7%）使用直接作用口服抗凝药物，96例（2.8%）使用依诺肝素或肝素。中位年龄为82岁（四分位间距65-107），以女性居多（55.2%），几乎全部为白种人（84.3%）。3425人中有229人确诊为急性脑出血（6.7%，95%可信区间为6-8%），13人确诊为迟发性脑出血（0.4%，95%可信区间为0.2-0.6%）。服用抗凝剂的患者与未服用抗凝剂的患者延迟性脑出血发生率无差异（p = 0.45）。结论老年ED头部外伤患者在使用损伤前抗凝剂治疗后迟发性脑出血的发生率很低。我们的数据对于使用抗凝剂治疗的老年ED患者钝性头部创伤的处理具有重要的临床意义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine