J.J. Martínez-Rivas , F. Rodríguez-Lucas , G. Planells , D. Corrales , D. Cocho
{"title":"轻度脑外伤和抗血栓治疗的脑出血风险","authors":"J.J. Martínez-Rivas , F. Rodríguez-Lucas , G. Planells , D. Corrales , D. Cocho","doi":"10.1016/j.rce.2023.09.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>The observation time in mild traumatic brain injury (mTBI) is controversial. Our aim was to assess the risk of neurological complications in mTBI with and without antithrombotic treatment.</p></div><div><h3>Method</h3><p>We retrospectively evaluated patients with mTBI seen in the emergency room for 3 years. We considered MTBI those with Glasgow ≥13 at admission. A cranial CT was performed in all cases with <u>></u>1 risk factor at admission and at 24<!--> <!-->h in those with neurological impairment or initial pathological cranial CT. Complications in the following 3 months were retrospectively reviewed.</p></div><div><h3>Results</h3><p>We evaluated 907 patients with a mean age of 73<!--> <!-->±<!--> <!-->19 years. Ninety-one percent presented risk factors, with 60% on antithrombotic treatment. We detected 11% of initial brain hemorrhage, 0.4% at 24<!--> <!-->h, and no cases at 3 months. Antithrombotic treatment was not associated with an increased risk of brain hemorrhage (9.9% with vs. 11.9% without treatment, <em>P</em>=.3). 39% of the hemorrhages presented neurological symptoms (18% post-traumatic amnesia, 12% headache, 8% vomiting, 1% seizures), with 78.4% having mild symptoms. Of the 4 hemorrhages detected at 24<!--> <!-->h, 3 were asymptomatic and one case that worsened the initial headache. No asymptomatic patient without lesion on initial clinical cranial CT presented at 24<!--> <!-->h.</p></div><div><h3>Conclusions</h3><p>Our study suggests that patients with asymptomatic mTBI, without a lesion on the initial cranial CT, would not require the observation period or CT control regardless of antithrombotic treatment or INR level.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Riesgo de hemorragia cerebral en el traumatismo craneal leve y tratamiento antitrombótico\",\"authors\":\"J.J. Martínez-Rivas , F. Rodríguez-Lucas , G. Planells , D. Corrales , D. Cocho\",\"doi\":\"10.1016/j.rce.2023.09.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>The observation time in mild traumatic brain injury (mTBI) is controversial. Our aim was to assess the risk of neurological complications in mTBI with and without antithrombotic treatment.</p></div><div><h3>Method</h3><p>We retrospectively evaluated patients with mTBI seen in the emergency room for 3 years. We considered MTBI those with Glasgow ≥13 at admission. A cranial CT was performed in all cases with <u>></u>1 risk factor at admission and at 24<!--> <!-->h in those with neurological impairment or initial pathological cranial CT. Complications in the following 3 months were retrospectively reviewed.</p></div><div><h3>Results</h3><p>We evaluated 907 patients with a mean age of 73<!--> <!-->±<!--> <!-->19 years. Ninety-one percent presented risk factors, with 60% on antithrombotic treatment. We detected 11% of initial brain hemorrhage, 0.4% at 24<!--> <!-->h, and no cases at 3 months. Antithrombotic treatment was not associated with an increased risk of brain hemorrhage (9.9% with vs. 11.9% without treatment, <em>P</em>=.3). 39% of the hemorrhages presented neurological symptoms (18% post-traumatic amnesia, 12% headache, 8% vomiting, 1% seizures), with 78.4% having mild symptoms. Of the 4 hemorrhages detected at 24<!--> <!-->h, 3 were asymptomatic and one case that worsened the initial headache. 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Riesgo de hemorragia cerebral en el traumatismo craneal leve y tratamiento antitrombótico
Introduction
The observation time in mild traumatic brain injury (mTBI) is controversial. Our aim was to assess the risk of neurological complications in mTBI with and without antithrombotic treatment.
Method
We retrospectively evaluated patients with mTBI seen in the emergency room for 3 years. We considered MTBI those with Glasgow ≥13 at admission. A cranial CT was performed in all cases with >1 risk factor at admission and at 24 h in those with neurological impairment or initial pathological cranial CT. Complications in the following 3 months were retrospectively reviewed.
Results
We evaluated 907 patients with a mean age of 73 ± 19 years. Ninety-one percent presented risk factors, with 60% on antithrombotic treatment. We detected 11% of initial brain hemorrhage, 0.4% at 24 h, and no cases at 3 months. Antithrombotic treatment was not associated with an increased risk of brain hemorrhage (9.9% with vs. 11.9% without treatment, P=.3). 39% of the hemorrhages presented neurological symptoms (18% post-traumatic amnesia, 12% headache, 8% vomiting, 1% seizures), with 78.4% having mild symptoms. Of the 4 hemorrhages detected at 24 h, 3 were asymptomatic and one case that worsened the initial headache. No asymptomatic patient without lesion on initial clinical cranial CT presented at 24 h.
Conclusions
Our study suggests that patients with asymptomatic mTBI, without a lesion on the initial cranial CT, would not require the observation period or CT control regardless of antithrombotic treatment or INR level.
期刊介绍:
Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI).
The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Nine issues are published each year, including mostly originals, reviews and consensus documents.