K. M. Taghlabi1, A. Chaparro1, D. Marlor1, C. McCoy1, R. Winfield1, S. Eaton1 1University of Kansas Medical Center, Department Of Surgery, Kansas City, KANSAS, USA
Introduction: Controversy exists regarding the necessity of a repeat head CT (rHCT) in anticoagulated trauma patients sustaining head injury, following admission head CT (HCT) negative for bleeding. This study aimed to assess patient and imaging outcomes following rHCT in anticoagulated patients with mild traumatic brain injury (mTBI).
Methods: A retrospective review of anticoagulated trauma patients admitted to the trauma service at The University of Kansas Medical Center for traumatic brain injury (TBI) between July 2016 and June 2020. The outcome of rHCT (positive vs negative) was the primary grouping variable. Patients who were not anticoagulated, with GCS≤8 or bleeding on admission HCT were excluded. Data including demographics, transfers from an outside facility, injury mechanisms, comorbidities, ISS, AIS, anticoagulant and antiplatelet therapy (ACAP) therapy, patient and imaging outcomes, and further management following admission, repeat, and follow-up HCT were collected.
Results: A total of 1,738 patient charts were reviewed with 47 patients meeting inclusion criteria. The cohort was predominately male (n=25, 53.2%), with a median age of 70 years, median GCS 15, median ISS 5, and median AIS Head 2. Twenty-nine (61.7%) patients reported LOC. Eleven (23.4%) patients were transferred from an outside facility and 23 (48.9%) were tobacco users. The majority had a history of hypertension (68.1%) and 18 (38%) were on combination therapy (ASA/Plavix). Four (8.5%) patients had a positive rHCT. 3 (6.4%) patients received Keppra as an intracranial hemorrhage (ICH) prophylaxis. None of our patients had a delayed bleed requiring surgery or ICP monitoring. The median hospital LOS was 2 days. Fifteen (31.9%) patients were discharged within 24 hours and no in-hospital mortality was reported. On bivariate analysis that compared for differences between study groups, the number of patients transferred from an outside facility (p<0.01), ISS (p=0.04) and AIS head (p=0.04) correlated with positive rHCT.
Conclusion: The incidence of rHCT in anticoagulated patients with mTBI was 8.5%. There was no difference in outcomes between patients who had positive rHCT vs those with negative rHCT and no surgical interventions were needed. Our data suggests that patients in this population may not require rHCT and that monitoring clinical status may be adequate surveillance. Large multicenter prospective studies are merited to investigate the significance of rHCT in this patient population.
