Impact of age and anticoagulation: Need for neurosurgical intervention in trauma patients with mild traumatic brain injury
Impact of age and anticoagulation: Need for neurosurgical intervention in trauma patients with mild traumatic brain injury
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DOI：
10.1097/ta.0b013e31824b01af
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发表时间：
2012-07-01
影响因子：
3.4
通讯作者：
Badellino, Michael
中科院分区：
文献类型：
--
作者：
Moore, Margaret M.;Pasquale, Michael D.;Badellino, Michael
背景：在美国每年50万例脑损伤中，80%被认为是轻度（轻度创伤性脑损伤）。不幸的是，其中2%至3%随后会恶化并导致严重的神经功能障碍。老年人的脑内变化、长期口服抗凝剂和血小板抑制可能导致轻微脑损伤后颅内出血的发生。我们试图调查年龄、抗凝和抗血小板治疗的使用与轻度创伤性脑损伤患者神经功能恶化和神经外科干预需求之间的关系。对所有成年人的回顾性研究（>14岁）入院接受I级创伤服务的格拉斯哥昏迷评分（GCS）患者评分为14 - 15的患者在住院期间接受神经外科干预。患者分为两组，年龄= 65岁。然后根据抗凝剂的使用对每组进一步分层：华法林、阿司匹林、氯吡格雷或联合用药。评估损伤机制、院前主诉、入院GCS、神经外科干预类型、重症监护室住院时间、住院时间和出院处置。Z检验和逻辑回归被用来比较比例或百分比从不同groups.RESULTS：在研究期间评估的7,678例患者中，101（1.3%）需要神经外科干预。>= 65岁的人群进行了显着更多的干预措施，这些患者对anticoagulants.CONCLUSION：所有年龄在65岁或以上的患者，谁提出了一个GCS评分>13后，头部外伤应进行筛选CT的头部，无论院前使用抗凝。如果年龄小于65岁的患者未接受抗凝治疗，则可根据主诉和损伤机制进行选择性筛选。（J Trauma Acute Care Surg.2012; 73：126-130.版权所有（C）2012 Lippincott威廉姆斯& Wilkins）
BACKGROUND: Of the 500,000 brain injuries in the United States annually, 80% are considered mild (mild traumatic brain injury). Unfortunately, 2% to 3% of them will subsequently deteriorate and result in severe neurologic dysfunction. Intracerebral changes in the elderly, chronic oral anticoagulation, and platelet inhibition may contribute to the development of intracranial bleeding after minor head injury. We sought to investigate the association of age and the use of anticoagulation and antiplatelet therapy with neurologic deterioration and the need for neurosurgical intervention in patients presenting with mild traumatic brain injury.METHODS: A retrospective review of all adult (>14 years) patients admitted to our Level I trauma service with a Glasgow Coma Scale (GCS) score of 14 to 15 who underwent neurosurgical intervention during their hospital stay was performed. Patients were stratified into two groups, age = 65 years. Each group was then further stratified by the use of anticoagulants: warfarin, aspirin, clopidogrel, or a combination. Mechanism of injury, prehospital complaints, admission GCS, type of neurosurgical intervention, intensive care unit length of stay, hospital length of stay, and discharge disposition were evaluated. Z test and logistic regression were used to compare proportions or percentages from different groups.RESULTS: Of the 7,678 patients evaluated during the study period, 101 (1.3%) required neurosurgical intervention. The >= 65 years population underwent significantly more interventions as did those patients on anticoagulants.CONCLUSION: All patients aged 65 years or older who present with a GCS score of >13 after head trauma should undergo a screening computed tomography of the head regardless of prehospital use of anticoagulation. Patients younger than 65 years can be selectively screened based on presenting complaints and mechanism of injury provided they are not on anticoagulation. (J Trauma Acute Care Surg. 2012; 73: 126-130. Copyright (C) 2012 by Lippincott Williams & Wilkins)