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JOURNAL ARTICLE
Joanna Wycech Knight, Alexander A Fokin, Nicholas Menzione, Sarah R Rabinowitz, Sari A Viitaniemi, Ivan Puente
OBJECTIVE: To compare outcomes between geriatric and non-geriatric patients with traumatic brain injury (TBI) transferred to trauma center and effects of anticoagulants/antiplatelets (AC/AP) and reversal therapy. METHODS: A retrospective review of 1,118 patients with TBI transferred from acute care facilities to level 1 trauma center compared in groups: geriatric versus non-geriatric, geriatric with AC/AP therapy versus without, and geriatric AC/AP with AC/AP reversal therapy versus without...
April 3, 2024: Brain Injury
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JOURNAL ARTICLE
Emily Niklasson, Elin Svensson, Lars André, Christian Areskoug, Jakob Lundager Forberg, Tomas Vedin
PURPOSE: Traumatic brain injury is the main reason for the emergency department visit of up to 3% of the patients and a major worldwide cause for morbidity and mortality. Current emergency management guidelines recommend close attention to patients taking oral anticoagulation but not patients on antiplatelet therapy. Recent studies have begun to challenge this. The aim of this study was to determine the impact of antiplatelet therapy and oral anticoagulation on traumatic intracranial hemorrhage...
March 21, 2024: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
#3
MULTICENTER STUDY
Susan Haag, John Kepros
BACKGROUND: Falls represent a large percentage of hospitalized patients with trauma as they may result in head injuries. Brain injury from ground-level falls (GLFs) in patients is common and has substantial mortality. As fall prevention initiatives have been inconclusive, we changed our strategy to injury prevention. We identified a head protection device (HPD) with impact-resistant technology, which meets head impact criteria sustained in a GLF. HPDs such as helmets are ubiquitous in preventing head injuries in sports and industrial activities; yet, they have not been studied for daily activities...
March 19, 2024: JMIR Human Factors
#4
JOURNAL ARTICLE
Margaret McGrath, Kasra Sarhadi, Mark H Harris, Eliza Baird-Daniel, Madeline Greil, Adriel Barrios-Anderson, Ellen Robinson, Christine T Fong, Andrew M Walters, Abhijit V Lele, Sarah Wahlster, Robert Bonow
INTRODUCTION: Patients with traumatic intracranial hemorrhage (tICH) are at increased risk of venous thromboembolism and may require anticoagulation. We evaluated the utility of surveillance computed tomography (CT) in patients with tICH who required therapeutic anticoagulation. METHODS: This single institution, retrospective study included adult patients with tICH who required anticoagulation within 4-weeks and had a surveillance head CT within 24-hours of reaching therapeutic anticoagulation levels...
March 13, 2024: World Neurosurgery
#5
JOURNAL ARTICLE
Walid K Salah, Matthew C Findlay, Cordell M Baker, Jonathan P Scoville, Michael Bounajem, Christopher Ogilvy, Justin Moore, Howard Riina, Elad I Levy, Adnan H Siddiqui, Alejandro Spiotta, C Michael Cawley, Alexander Khalessi, Omar Tanweer, Ricardo Hanel, Bradley Gross, Okkes Kuybu, Brian M Howard, Alex N Hoang, Ammad A Baig, MirHojjat Khorasanizadeh, Aldo A Mendez Ruiz, Gustavo Cortez, Jason M Davies, Mike Lang, Ajith J Thomas, Daniel Tonetti, Jane Khalife, Georgios S Sioutas, Kate Carroll, Zachary A Abecassis, Brian Jankowitz, Juan Francisco Ruiz Rodriguez, MIchael Levitt, Peter Kan, Jan Karl Burkhardt, Visish Srinivasan, Mohamed M Salem, Ramesh Grandhi
Middle meningeal artery embolization (MMAE) is emerging as a safe and effective standalone intervention for nonacute subdural hematomas (NASHs); however, the risk of hematoma recurrence after MMAE in coagulopathic patients is unclear. To characterize the impact of coagulopathy on treatment outcomes, we analyzed a multi-institutional database of patients who underwent standalone MMAE as treatment of NASH. We classified 537 patients who underwent MMAE as a standalone intervention between 2019 and 2023 by coagulopathy status...
March 13, 2024: Journal of Neurotrauma
#6
Phillip Mitchell Johansen, Bronson Ciavarra, Ryan McCormack, Matthew Kole, Gary Spiegel, Stephen Alan Fletcher
INTRODUCTION: Injury and subsequent thrombosis of the cerebral venous sinuses may be caused by closed head injuries secondary to a variety of different mechanisms. Skull fractures can lacerate or otherwise disrupt adjacent dural sinuses. The sequelae of such injuries may include thrombosis and either partial or total occlusion of the sinus, ultimately resulting in significant venous congestion. Sagittal sinus injury is associated with a more serious outcome due to the obligatory flow into the sinus, especially posterior to the coronal suture...
March 8, 2024: Pediatric Neurosurgery
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JOURNAL ARTICLE
Josh Elias, Emma Sutherland, Ewan Kennedy
OBJECTIVE: To map existing literature about concussion management in older people, identifying and analyzing gaps in our understanding. CONTEXT: Concussion injuries affect older people, yet little guidance is available about how to approach concussion management with older people. Research does not always include older populations, and it is unclear to what extent standard concussion management is appropriate for older people. DESIGN: Scoping review...
February 27, 2024: Journal of Head Trauma Rehabilitation
#8
JOURNAL ARTICLE
Marcel Nwizu, Thomas Weiner, Tony Downs, Jessica Krizo, Caroline Mangira, Stacy Cowan, Ali Mallat, Ashley Heaney
BACKGROUND: Intracerebral hemorrhage (ICH) is a potential complication from traumatic brain injury, with a 30-day mortality rate of 35-52%. Rapid diagnosis allows for earlier treatment, which impacts patient outcomes. A trauma activation (TA) is called when injury severity meets institutional criteria. The patient is immediately roomed, and a multispecialty team is present. A trauma evaluation (TE) occurs when injuries are identified after standard triage processes. OBJECTIVES: Our aim was to determine whether TA patients with ICH were diagnosed and treated more rapidly than TE patients...
November 10, 2023: Journal of Emergency Medicine
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JOURNAL ARTICLE
Terry Nash, Nicola MacRae, Daniel Pitt, Casey Bennetts, Alyce Scanlan, Robert Eley
OBJECTIVE: Identify the incidence of intracranial haemorrhage in people from residential aged care facilities following falls who had a CT head performed. The secondary objectives were to identify predictor variables for intracranial haemorrhage to inform person-centred shared decision making. METHODS: Retrospective chart review of aged care residents who presented to ED with a triage of fall. Documented evidence of vomiting, headache, external signs of head injury, deviation from baseline neurology and the presence of anticoagulation or antiplatelet agents was reviewed...
February 28, 2024: Emergency Medicine Australasia: EMA
#10
JOURNAL ARTICLE
Michael Fisher, Kristin Salottolo, Matthew Carrick, Chad M Corrigan, Kaysie L Banton, Robert Madayag, David Bar-Or
OBJECTIVE: The perioperative management of patients on antiplatelet drugs is a rising challenge in orthopedic trauma because antiplatelet drugs are frequently encountered and carry an increased risk of hemorrhagic consequences. The study objective was to examine the effect of aspirin on bleeding outcomes for patients with lower extremity fractures. METHODS: This retrospective study included patients requiring surgical fixation of traumatic hip, femur, and tibia fractures from January 1, 2018, to March 1, 2020...
2024: Trauma Surgery & Acute Care Open
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JOURNAL ARTICLE
Alyesha Proctor, Mark Lyttle, Jedd Billing, Pauline Shaw, Julian Simpson, Sarah Voss, Jonathan Richard Benger
OBJECTIVE: Hospital-based clinical decision tools support clinician decision-making when a child presents to the emergency department with a head injury, particularly regarding CT scanning. However, there is no decision tool to support prehospital clinicians in deciding which head-injured children can safely remain at scene. This study aims to identify clinical decision tools, or constituent elements, which may be adapted for use in prehospital care. DESIGN: Systematic mapping review and narrative synthesis...
February 13, 2024: BMJ Open
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JOURNAL ARTICLE
Sai Krishna Bhogadi, Adam Nelson, Hamidreza Hosseinpour, Tanya Anand, Omar Hejazi, Christina Colosimo, Audrey L Spencer, Michael Ditillo, Louis J Magnotti, Bellal Joseph
INTRODUCTION: This study aims to evaluate effect of 4-factor PCC on outcomes of severe TBI patients on preinjury anticoagulants undergoing craniotomy/craniectomy. METHODS: In this analysis of 2018-2020 ACS-TQIP, patients with isolated blunt severe TBI (Head-AIS≥3, nonhead-AIS<2) using preinjury anticoagulants who underwent craniotomy/craniectomy were identified and stratified into PCC and No-PCC groups. Outcomes were time to surgery and mortality. Multivariable binary logistic and linear regression analyses were performed...
January 30, 2024: American Journal of Surgery
#13
Jun-Ming Lin, Xiao-Jun Yuan, Guang Li, Xin-Rong Gan, Wen-Hua Xu
BACKGROUND: Elevated levels of cardiac troponin and abnormal electrocardiogram changes are the primary basis for clinical diagnosis of acute coronary syndrome (ACS). Troponin levels in ACS patients can often be more than 50 times the upper reference limit. Some patients with subarachnoid hemorrhage (SAH) also show electrocardiogram abnormalities, myocardial damage, and elevated cardiac biomarkers. Unlike ACS patients, patients with SAH only have a slight increase in troponin, and the use of anticoagulants or antiplatelet drugs is prohibited...
January 6, 2024: World Journal of Clinical Cases
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JOURNAL ARTICLE
Erin Sadek, William Curtiss, Jessica Andrews, Jason Hecht
BACKGROUND: Andexanet alfa was approved in 2018 for reversal of direct oral anticoagulants but due to issues of cost and access, four-factor prothrombin complex concentrate (4F-PCC) continues to be used for this indication. The objective of this study is to evaluate outcomes of reversal with these agents in patients with isolated traumatic brain injuries (TBI). METHODS: This is a retrospective review of 35 trauma centres from 2014 to 2021. Patients were included with an Abbreviated Injury Scale (AIS)>2 for head and having received andexanet alfa or 4F-PCC within 24 hours of admission...
February 20, 2024: Emergency Medicine Journal: EMJ
#15
JOURNAL ARTICLE
William Kelley, Khaled Zreik, Anna Gergen, Jamie Williams, Lewis E Jacobson, Jeffry Nahmias, Anthony Tatar, Jason Murry, Areg Grigorian, Adrian Ong, Deborah M Stein, Thomas M Scalea, Margaret H Lauerman
BACKGROUND: Blunt cerebrovascular injury (BCVI) with concurrent traumatic brain injury (TBI) presents increased risk of both ischemic stroke and bleeding. This study investigated the safety and survival benefit of BCVI treatment (antithrombotic and/or anticoagulant therapy) in this population. We hypothesized that treatment would be associated with fewer and later strokes in patients with BCVI and TBI without increasing bleeding complications. METHODS: Patients with head AIS >0 were selected from a database of BCVI patients previously obtained for an observational trial...
January 22, 2024: American Surgeon
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JOURNAL ARTICLE
Vincenzo G Menditto, Marco Moretti, Lucia Babini, Annalisa Mattioli, Andres Ramon Giuliani, Marina Fratini, Fabienne Yvonne Pallua, Elisa Andreoli, Cinzia Nitti, Susanna Contucci, Armando Gabrielli, Marco Bruno Luigi Rocchi, Giovanni Pomponio
OBJECTIVES: Data in literature indicate that in patients suffering a minor head injury (MHI), biomarkers serum levels could be effective to predict the absence of intracranial injury (ICI) on head CT scan. Use of these biomarkers in case of patients taking oral anticoagulants who experience MHI is very limited. We investigated biomarkers as predictors of ICI in anticoagulated patients managed in an ED. METHODS: We conducted a single-cohort, prospective, observational study in an ED...
January 12, 2024: Clinical Chemistry and Laboratory Medicine: CCLM
#17
JOURNAL ARTICLE
Kelly Powell, William Curtiss, Erin Sadek, Jason Hecht
INTRODUCTION: Falls are the leading cause of injury in older individuals, with intracranial hemorrhage (ICH) being a common complication. Anticoagulants, such as vitamin K antagonist and direct oral anticoagulants, are increasingly utilized, and clinicians may question the necessity of reversal in patients with minor ICH, especially in the setting of increased risk of adverse events. This study aimed to identify a population of patients with minor traumatic ICH at low risk for poor-neurologic status where anticoagulant reversal may not improve outcomes...
December 23, 2023: Pharmacotherapy
#18
JOURNAL ARTICLE
Kevin Raymond, Alexander Sterling, Mary Roberts, Reuben W Holland Iii, S Galwankar, Rakesh Kumar Mishra, Amit Agrawal
OBJECTIVES: Anticoagulants and antiplatelet (ACAP) agents are increasingly and frequently used, especially in the elderly. The present study was carried out to assess the prevalence of delayed traumatic intracranial hemorrhage (dtICH) after a normal result on an initial head computed tomography (CT) in adults who were taking ACAP medication. MATERIALS AND METHODS: The present retrospective included all adult patients who arrived in the emergency department between January 2017 and January 2021 with a history of fall from the patient's own height, while being on ACAP medication with an isolated head injury...
2023: Journal of Neurosciences in Rural Practice
#19
JOURNAL ARTICLE
V G Menditto, M Moretti, L Babini, M Sampaolesi, M Buzzo, L Montillo, A Raponi, F Riccomi, M Marcosignori, M Rocchi, G Pomponio
BACKGROUND: The optimal management of patients taking oral anticoagulants who experience minor head injury (MHI) is unclear. The availability of validated protocols and reliable predictors of prognosis would be of great benefit. We investigated clinical factors as predictors of clinical outcomes and intracranial injury (ICI). METHODS: We conducted a single-cohort, prospective, observational study in an ED. Our structured clinical pathway included a first head CT scan, 24 h observation and a second CT scan...
November 21, 2023: American Journal of Emergency Medicine
#20
JOURNAL ARTICLE
Kerstin de Wit, Mathew Mercuri, Natasha Clayton, Éric Mercier, Judy Morris, Rebecca Jeanmonod, Debra Eagles, Catherine Varner, David Barbic, Ian M Buchanan, Mariyam Ali, Yoan K Kagoma, Ashkan Shoamanesh, Paul Engels, Sunjay Sharma, Andrew Worster, Shelley McLeod, Marcel Émond, Ian Stiell, Alexandra Papaioannou, Sameer Parpia
BACKGROUND: Ground-level falls are common among older adults and are the most frequent cause of traumatic intracranial bleeding. The aim of this study was to derive a clinical decision rule that safely excludes clinically important intracranial bleeding in older adults who present to the emergency department after a fall, without the need for a computed tomography (CT) scan of the head. METHODS: This prospective cohort study in 11 emergency departments in Canada and the United States enrolled patients aged 65 years or older who presented after falling from standing on level ground, off a chair or toilet seat, or out of bed...
December 3, 2023: Canadian Medical Association Journal: CMAJ
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