{"title":"对轻度外伤性脑损伤的老年患者（75岁或以上）进行系统的头部计算机断层扫描仅基于抗血栓治疗的可能有限的理由。","authors":"Emma Jaffres , Jean-Nicolas Dacher , Mehdi Taalba , Frédéric Roca , Matthieu Garnier , Sébastien Normant , Mathieu Lozouet , Emmanuel Gérardin , Julien Burel","doi":"10.1016/j.redii.2024.100053","DOIUrl":null,"url":null,"abstract":"<div><h3>Rationale and objectives</h3><div>Recent literature suggests that performing systematic head computed tomography (CT) scans for mild traumatic brain injury (mTBI) in patients undergoing antithrombotic therapy offers limited benefits. This study aims to evaluate a set of criteria that could potentially eliminate the need for systematic head CT scans, performed solely because of the antithrombotic treatment status, in elderly patients (aged 75 or older) presenting with mTBI.</div></div><div><h3>Materials and methods</h3><div>All patients aged 75 or older who underwent a head CT scan at our academic center for mTBI while on antithrombotic therapy between January and December 2022 were retrospectively included in this study. Patients were categorized into two groups. The first group, referred to as the “At-risk group”, included patients with any of the following: GCS score < 15 or cognitive impairment; initial loss of consciousness; hemodynamic instability; signs of fractures; extensive subcutaneous hematoma; severe or treatment-resistant headache; vomiting; seizure; any neurological deficit; intoxication; amnesia; or a history of neurosurgery. The second group, referred to as the “Not-at-risk group”, comprised patients without any of these criteria.</div></div><div><h3>Results</h3><div>A total of 1415 patients were included. Post-traumatic intracranial hemorrhage (<em>P</em> < 0.001), brain herniation (<em>P</em> = 0.003), and fractures (<em>P</em> < 0.001) occurred statistically more frequently in the At-risk group. Six post-traumatic hemorrhagic brain injuries were found in the Not-at-risk group, that did not present any of the studied criteria, and all these injuries were minor (localized SAH; millimetric SDH). Furthermore, none of these required immediate or delayed surgical intervention, and no neurological deterioration or deaths occurred in these patients.</div></div><div><h3>Conclusion</h3><div>In conclusion, conducting systematic head CT scans based solely on antithrombotic therapy in elderly patients aged 75 or older with mTBI might be irrelevant.</div></div>","PeriodicalId":74676,"journal":{"name":"Research in diagnostic and interventional imaging","volume":"13 ","pages":"Article 100053"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786775/pdf/","citationCount":"0","resultStr":"{\"title\":\"Possible limited justification for systematic head computed tomography scans based solely on antithrombotic therapy in elderly patients (aged 75 or older) with mild traumatic brain injury\",\"authors\":\"Emma Jaffres , Jean-Nicolas Dacher , Mehdi Taalba , Frédéric Roca , Matthieu Garnier , Sébastien Normant , Mathieu Lozouet , Emmanuel Gérardin , Julien Burel\",\"doi\":\"10.1016/j.redii.2024.100053\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Rationale and objectives</h3><div>Recent literature suggests that performing systematic head computed tomography (CT) scans for mild traumatic brain injury (mTBI) in patients undergoing antithrombotic therapy offers limited benefits. This study aims to evaluate a set of criteria that could potentially eliminate the need for systematic head CT scans, performed solely because of the antithrombotic treatment status, in elderly patients (aged 75 or older) presenting with mTBI.</div></div><div><h3>Materials and methods</h3><div>All patients aged 75 or older who underwent a head CT scan at our academic center for mTBI while on antithrombotic therapy between January and December 2022 were retrospectively included in this study. Patients were categorized into two groups. The first group, referred to as the “At-risk group”, included patients with any of the following: GCS score < 15 or cognitive impairment; initial loss of consciousness; hemodynamic instability; signs of fractures; extensive subcutaneous hematoma; severe or treatment-resistant headache; vomiting; seizure; any neurological deficit; intoxication; amnesia; or a history of neurosurgery. The second group, referred to as the “Not-at-risk group”, comprised patients without any of these criteria.</div></div><div><h3>Results</h3><div>A total of 1415 patients were included. Post-traumatic intracranial hemorrhage (<em>P</em> < 0.001), brain herniation (<em>P</em> = 0.003), and fractures (<em>P</em> < 0.001) occurred statistically more frequently in the At-risk group. Six post-traumatic hemorrhagic brain injuries were found in the Not-at-risk group, that did not present any of the studied criteria, and all these injuries were minor (localized SAH; millimetric SDH). Furthermore, none of these required immediate or delayed surgical intervention, and no neurological deterioration or deaths occurred in these patients.</div></div><div><h3>Conclusion</h3><div>In conclusion, conducting systematic head CT scans based solely on antithrombotic therapy in elderly patients aged 75 or older with mTBI might be irrelevant.</div></div>\",\"PeriodicalId\":74676,\"journal\":{\"name\":\"Research in diagnostic and interventional imaging\",\"volume\":\"13 \",\"pages\":\"Article 100053\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-01-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786775/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Research in diagnostic and interventional imaging\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2772652524000140\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Research in diagnostic and interventional imaging","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772652524000140","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Possible limited justification for systematic head computed tomography scans based solely on antithrombotic therapy in elderly patients (aged 75 or older) with mild traumatic brain injury
Rationale and objectives
Recent literature suggests that performing systematic head computed tomography (CT) scans for mild traumatic brain injury (mTBI) in patients undergoing antithrombotic therapy offers limited benefits. This study aims to evaluate a set of criteria that could potentially eliminate the need for systematic head CT scans, performed solely because of the antithrombotic treatment status, in elderly patients (aged 75 or older) presenting with mTBI.
Materials and methods
All patients aged 75 or older who underwent a head CT scan at our academic center for mTBI while on antithrombotic therapy between January and December 2022 were retrospectively included in this study. Patients were categorized into two groups. The first group, referred to as the “At-risk group”, included patients with any of the following: GCS score < 15 or cognitive impairment; initial loss of consciousness; hemodynamic instability; signs of fractures; extensive subcutaneous hematoma; severe or treatment-resistant headache; vomiting; seizure; any neurological deficit; intoxication; amnesia; or a history of neurosurgery. The second group, referred to as the “Not-at-risk group”, comprised patients without any of these criteria.
Results
A total of 1415 patients were included. Post-traumatic intracranial hemorrhage (P < 0.001), brain herniation (P = 0.003), and fractures (P < 0.001) occurred statistically more frequently in the At-risk group. Six post-traumatic hemorrhagic brain injuries were found in the Not-at-risk group, that did not present any of the studied criteria, and all these injuries were minor (localized SAH; millimetric SDH). Furthermore, none of these required immediate or delayed surgical intervention, and no neurological deterioration or deaths occurred in these patients.
Conclusion
In conclusion, conducting systematic head CT scans based solely on antithrombotic therapy in elderly patients aged 75 or older with mTBI might be irrelevant.
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