The prevalence of clinically relevant delayed intracranial hemorrhage in head trauma patients treated with oral anticoagulants is very low: a retrospective cohort register study
(2024) In Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 32. p.1-9- Abstract
- Background
Current guidelines from Scandinavian Neuro Committee mandate a 24-hour observation for head trauma patients on anticoagulants, even with normal initial head CT scans, as a means not to miss delayed intracranial hemorrhages. This study aimed to assess the prevalence, and time to diagnosis, of clinically relevant delayed intracranial hemorrhage in head trauma patients treated with oral anticoagulants.
Method
Utilizing comprehensive two-year data from Region Skåne’s emergency departments, which serve a population of 1.3 million inhabitants, this study focused on adult head trauma patients prescribed oral anticoagulants. We identified those with intracranial hemorrhage within 30 days, defining delayed intracranial... (More) - Background
Current guidelines from Scandinavian Neuro Committee mandate a 24-hour observation for head trauma patients on anticoagulants, even with normal initial head CT scans, as a means not to miss delayed intracranial hemorrhages. This study aimed to assess the prevalence, and time to diagnosis, of clinically relevant delayed intracranial hemorrhage in head trauma patients treated with oral anticoagulants.
Method
Utilizing comprehensive two-year data from Region Skåne’s emergency departments, which serve a population of 1.3 million inhabitants, this study focused on adult head trauma patients prescribed oral anticoagulants. We identified those with intracranial hemorrhage within 30 days, defining delayed intracranial hemorrhage as a bleeding not apparent on their initial CT head scan. These cases were further defined as clinically relevant if associated with mortality, any intensive care unit admission, or neurosurgery.
Results
Out of the included 2,362 head injury cases (median age 84, 56% on a direct acting oral anticoagulant), five developed delayed intracranial hemorrhages. None of these five cases underwent neurosurgery nor were admitted to an intensive care unit. Only two cases (0.08%, 95% confidence interval [0.01–0.3%]) were classified as clinically relevant, involving subdural hematomas in patients aged 82 and 87 years, who both subsequently died. The diagnosis of these delayed intracranial hemorrhages was made at 4 and 7 days following initial presentation to the emergency department.
Conclusion
In patients with head trauma, on oral anticoagulation, the incidence of clinically relevant delayed intracranial hemorrhage was found to be less than one in a thousand, with detection occurring four days or later after initial presentation. This challenges the effectiveness of the 24-hour observation period recommended by the Scandinavian Neurotrauma Committee guidelines, suggesting a need to reassess these guidelines to optimise care and resource allocation. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/feb8bd87-4806-4e87-b1a6-0929fd1e0e57
- author
- André, Lars LU ; Björkelund, Anders LU ; Ekelund, Ulf LU ; Vedin, Tomas LU ; Björk, Jonas LU and Lundager Forberg, Jakob LU
- organization
-
- Clinical Sciences, Helsingborg
- Electrocardiology Research Group - CIEL (research group)
- Computational Science for Health and Environment (research group)
- EpiHealth: Epidemiology for Health
- Emergency medicine (research group)
- LU Profile Area: Nature-based future solutions
- EPI@LUND (research group)
- Surgery and public health (research group)
- eSSENCE: The e-Science Collaboration
- publishing date
- 2024-05-10
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
- volume
- 32
- article number
- 42
- pages
- 1 - 9
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:38730480
- scopus:85192745253
- ISSN
- 1757-7241
- DOI
- 10.1186/s13049-024-01214-0
- language
- English
- LU publication?
- yes
- id
- feb8bd87-4806-4e87-b1a6-0929fd1e0e57
- date added to LUP
- 2024-05-17 13:10:46
- date last changed
- 2024-05-20 07:42:06
@article{feb8bd87-4806-4e87-b1a6-0929fd1e0e57, abstract = {{Background<br/>Current guidelines from Scandinavian Neuro Committee mandate a 24-hour observation for head trauma patients on anticoagulants, even with normal initial head CT scans, as a means not to miss delayed intracranial hemorrhages. This study aimed to assess the prevalence, and time to diagnosis, of clinically relevant delayed intracranial hemorrhage in head trauma patients treated with oral anticoagulants.<br/><br/>Method<br/>Utilizing comprehensive two-year data from Region Skåne’s emergency departments, which serve a population of 1.3 million inhabitants, this study focused on adult head trauma patients prescribed oral anticoagulants. We identified those with intracranial hemorrhage within 30 days, defining delayed intracranial hemorrhage as a bleeding not apparent on their initial CT head scan. These cases were further defined as clinically relevant if associated with mortality, any intensive care unit admission, or neurosurgery.<br/><br/>Results<br/>Out of the included 2,362 head injury cases (median age 84, 56% on a direct acting oral anticoagulant), five developed delayed intracranial hemorrhages. None of these five cases underwent neurosurgery nor were admitted to an intensive care unit. Only two cases (0.08%, 95% confidence interval [0.01–0.3%]) were classified as clinically relevant, involving subdural hematomas in patients aged 82 and 87 years, who both subsequently died. The diagnosis of these delayed intracranial hemorrhages was made at 4 and 7 days following initial presentation to the emergency department.<br/><br/>Conclusion<br/>In patients with head trauma, on oral anticoagulation, the incidence of clinically relevant delayed intracranial hemorrhage was found to be less than one in a thousand, with detection occurring four days or later after initial presentation. This challenges the effectiveness of the 24-hour observation period recommended by the Scandinavian Neurotrauma Committee guidelines, suggesting a need to reassess these guidelines to optimise care and resource allocation.}}, author = {{André, Lars and Björkelund, Anders and Ekelund, Ulf and Vedin, Tomas and Björk, Jonas and Lundager Forberg, Jakob}}, issn = {{1757-7241}}, language = {{eng}}, month = {{05}}, pages = {{1--9}}, publisher = {{BioMed Central (BMC)}}, series = {{Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine}}, title = {{The prevalence of clinically relevant delayed intracranial hemorrhage in head trauma patients treated with oral anticoagulants is very low: a retrospective cohort register study}}, url = {{http://dx.doi.org/10.1186/s13049-024-01214-0}}, doi = {{10.1186/s13049-024-01214-0}}, volume = {{32}}, year = {{2024}}, }