S. Mansour1,2, A. Tymchak1,2,3, A. Zuviv2, M. Crawford2, J. Wycech2,3, A. A. Fokin2, I. Puente1,2,3,4 1Florida Atlantic University,College Of Medicine,Boca Raton, FL, USA 2Delray Medical Center,Trauma Services,Delray Beach, FL, USA 3Broward Health Medical Center,Trauma Services,Fort Lauderdale, FL, USA 4Florida International University,College Of Medicine,Miami, FL, USA
Introduction:
There is a debate on the efficacy of repeat head computed tomography (RHCT) in traumatic brain injury (TBI). There is also a trend to increase precautions taken with elderly TBI patients, especially those on antiplatelet therapy (APT). Our study seeks to assess the need for RHCT in TBI patients on pre-injury APT who had negative findings on the initial head CT (IHCT).
Methods:
This IRB approved retrospective cohort study included 58 TBI patients on pre-injury Aspirin, Clopidogrel or both between the ages of 17 and 101, who were delivered to a level 1 trauma center between 1/1/2015 and 3/30/2018 and had a negative IHCT. Patients were excluded if they were also taking anti-coagulants. Patients were divided into 2 groups: Group 1 with those who did not receive RHCT (n=31) and Group 2 with those who received RHCT (n=27). Age, Injury Severity Score (ISS), Revised Trauma Score (RTS), Glasgow Coma Score (GCS), Rotterdam CT score, Marshall CT score, incidence of intracranial hemorrhage (ICH), platelet count on admission, Prothrombin Time (PT), Partial Thromboplastin Time (PTT), platelet transfusion, venous thromboembolism (VTE) prophylaxis, need for neurosurgical intervention, Intensive Care Unit length of stay (ICULOS), hospital LOS (HLOS), incidence of re-admission and mortality were compared.
Results:
Group 2 had statistically higher mean Rotterdam score (2.0 vs 2.4; p<0.001), incidence of ICH (0.0% vs 48.1%; p<0.001; Fig. 1) and need for platelet transfusions (37.0% vs 9.7%; p=0.01) than patients in Group 1. Furthermore, Group 2 also had a higher percentage of patients who were taking Clopidogrel than Group 1 (25.3% vs 59.3%; p=0.01).
Between Groups 1 and 2, age (80.7 vs 79.6; p=0.4), ISS (8.1 vs 9.0; p=0.6), RTS (7.8 vs 7.8; p=1.0), GCS (14.6 vs 14.5; p=0.9), Marshall score (1.0 vs 1.0; p=1.0), platelet count (246.0 vs 191.0; p=0.2), PT (11.1 vs 10.9 seconds; p=0.1), PTT (26.2 vs 26.6 seconds; p=0.7), VTE prophylaxis (3.1% vs 9.4%; p=0.3), rate of neurosurgical interventions (0.0% vs 6.3%; p=0.2), ICULOS (4.2 vs 2.6 days; p=0.4), HLOS (4.5 vs 2.6 days; p=0.2) and readmission rate (3.2% vs 3.7%; p=0.9) were similar. No patients died in either group.
Conclusion:
In patients with head trauma on APT who had negative IHCT, repeat CT showed ICH in 48.1% of them, however there was no difference in outcomes between patients who did and did not receive RHCT. This can be explained by a relatively small volume of hemorrhage in these patients as demonstrated by mean Marshal Score of 1.0 in these patients. Physicians were more likely to repeat CT scans in patients on Clopidogrel.
