Management of mild traumatic brain injury–trauma energy level and medical history as possible predictors for intracranial hemorrhage

Research output: Contribution to journalArticle

Abstract

Purpose: Head trauma is common in the emergency department. Identifying the few patients with serious injuries is time consuming and leads to many computerized tomographies (CTs). Reducing the number of CTs would reduce cost and radiation. The aim of this study was to evaluate the characteristics of adults with head trauma over a 1-year period to identify clinical features predicting intracranial hemorrhage. Methods: Medical record data have been collected retrospectively in adult patients with traumatic brain injury. A total of 1638 patients over a period of 384 days were reviewed, and 33 parameters were extracted. Patients with high-energy multitrauma managed with ATLS™ were excluded. The analysis was done with emphasis on patient history, clinical findings, and epidemiological traits. Logistic regression and descriptive statistics were applied. Results: Median age was 58 years (18–101, IQR 35–77). High age, minor head injury, new neurological deficits, and low trauma energy level correlated with intracranial hemorrhage. Patients younger than 59 years, without anticoagulation or antiplatelet therapy who suffered low-energy trauma, had no intracranial hemorrhages. The hemorrhage frequency in the entire cohort was 4.3% (70/1638). In subgroup taking anticoagulants, the frequency of intracranial hemorrhage was 8.6% (10/116), and in the platelet-inhibitor subgroup, it was 11.8% (20/169). Conclusion: This study demonstrates that patients younger than 59 years with low-energy head trauma, who were not on anticoagulants or platelet inhibitors could possibly be discharged based on patient history. Maybe, there is no need for as extensive medical examination as currently recommended. These findings merit further studies.

Details

Authors
Organisations
External organisations
  • Karolinska Institutet
  • Umeå University
  • Karlstad Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Anesthesiology and Intensive Care

Keywords

  • Brain injuries, Epidemiology, Intracranial hemorrhage, Practice guidelines as topic, S100B Calcium Binding Protein Beta Subunit, Traumatic
Original languageEnglish
Pages (from-to)901-907
Number of pages7
JournalEuropean Journal of Trauma and Emergency Surgery
Volume45
Issue number5
Early online date2018 Mar 17
Publication statusPublished - 2019 Oct
Publication categoryResearch
Peer-reviewedYes

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