Risk factors associated with intracranial bleeding and neurosurgery in patients with mild traumatic brain injury who are receiving direct oral anticoagulants
| Autor: | Massimo Zannoni, Giorgio Ricci, Norbert Pfeifer, Antonio Maccagnani, Andrea Tenci, Arian Zaboli, Gianni Turcato, Antonio Bonora, Laura Ciccariello, Elisabetta Zorzi |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Multivariate analysis Traumatic brain injury Poison control Amnesia Neurosurgical Procedures 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans Glasgow Coma Scale Brain Concussion Retrospective Studies business.industry 030208 emergency & critical care medicine Retrospective cohort study General Medicine Odds ratio medicine.disease Intracranial Hemorrhage Traumatic ROC Curve Case-Control Studies Emergency medicine Emergency Medicine Female Neurosurgery medicine.symptom business Factor Xa Inhibitors |
| Zdroj: | The American journal of emergency medicine. 43 |
| ISSN: | 1532-8171 |
| Popis: | The established clinical risk factors for post-traumatic intracranial bleeding have not been evaluated in patients receiving DOACs yet.Evaluating the association between clinic and patient characteristics and post-traumatic intracranial bleeding (ICH) in patients with mild traumatic brain injury (MTBI) and DOACs.This is a retrospective observational study conducted on three Emergency Departments. Multivariate analysis provided association in terms of OR with the risk of ICH. The performance of the multivariate model, described in a nomogram, has been tested with discrimination and decision curve analysis.Of 473 DOACs patients with MTBI, 8.5% had post-traumatic ICH. On multivariable analysis, major dynamics (odds ratio [OR] 6.255), post-traumatic amnesia (OR 3.961), post-traumatic loss of consciousness (LOC, OR 7.353), Glasgow Coma Scale (GCS) score 15 (OR 3.315), post-traumatic headache (OR 4.168) and visible trauma above the clavicles (OR 3.378) were associated with a higher likelihood of ICH. The multivariate model, used for the nomogram construction, showed a good performance (AUC bias corrected with 5000 bootstraps resample 0.78). The DCAs showed a net clinical benefit of the prognostic model.Clinical risk factors can be used in DOACs patients to better define the risk of post-traumatic ICH. |
| Databáze: | OpenAIRE |
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