Repeat head computed tomography in anticoagulated traumatic brain injury patients: Still warranted

Bellal Joseph, Moutamn Sadoun, Hassan Aziz, Andrew Tang, Julie L. Wynne, Viraj Pandit, Narong Kulvatunyou, Terence OKeeffe, Randall S. Friese, Peter Rhee

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Anticoagulation agents are proven risk factors for intracranial hemorrhage (ICH) in traumatic brain injury (TBI). The aim of our study is to describe the epidemiology of prehospital coumadin, aspirin, and Plavix (CAP) patients with ICH and evaluate the use of repeat head computed tomography (CT) in this group. We performed a retrospective study from our trauma registry. All patients with intracranial hemorrhage on initial CTwith prehospital CAP therapy were included. Demographics, CT scan findings, number of repeat CT scans, progressive findings, and neurosurgical intervention were abstracted. A comparison between prehospital CAP and no-CAP patients was done using x2 and Mann-Whitney U test. A total of 1606 patients with blunt TBI charts were reviewed of whom 508 patients had intracranial bleeding on initial CT scan and 72 were on prehospital CAP therapy. CAP patients were older (P\0.001), had higher Injury Severity Score and head Abbreviated Injury Scores on admission (P\0.001), were more likely to present with an abnormal neurologic examination (P 5 0.004), and had higher hospital and intensive care unit lengths of stay (P\0.005). Eighty-four per cent of patients were on antiplatelet therapy and 27 per cent were on warfarin. The CAP patients have a threefold increase in the rate of worsening repeat head CT (26 vs 9%, P\0.05). Prehospital CAP therapy is high risk for progression of bleeding on repeat head CT. Routine repeat head CT remains an important component in this patient population and can provide useful information.

Original languageEnglish (US)
Pages (from-to)43-47
Number of pages5
JournalAmerican Surgeon
Volume80
Issue number1
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

clopidogrel
Warfarin
Aspirin
Head
Tomography
Intracranial Hemorrhages
Hemorrhage
Traumatic Brain Injury
Injury Severity Score
Neurologic Examination
Therapeutics
Nonparametric Statistics
Craniocerebral Trauma
Anticoagulants

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Joseph, B., Sadoun, M., Aziz, H., Tang, A., Wynne, J. L., Pandit, V., ... Rhee, P. (2014). Repeat head computed tomography in anticoagulated traumatic brain injury patients: Still warranted. American Surgeon, 80(1), 43-47.

Repeat head computed tomography in anticoagulated traumatic brain injury patients : Still warranted. / Joseph, Bellal; Sadoun, Moutamn; Aziz, Hassan; Tang, Andrew; Wynne, Julie L.; Pandit, Viraj; Kulvatunyou, Narong; OKeeffe, Terence; Friese, Randall S.; Rhee, Peter.

In: American Surgeon, Vol. 80, No. 1, 01.01.2014, p. 43-47.

Research output: Contribution to journalArticle

Joseph, B, Sadoun, M, Aziz, H, Tang, A, Wynne, JL, Pandit, V, Kulvatunyou, N, OKeeffe, T, Friese, RS & Rhee, P 2014, 'Repeat head computed tomography in anticoagulated traumatic brain injury patients: Still warranted', American Surgeon, vol. 80, no. 1, pp. 43-47.
Joseph B, Sadoun M, Aziz H, Tang A, Wynne JL, Pandit V et al. Repeat head computed tomography in anticoagulated traumatic brain injury patients: Still warranted. American Surgeon. 2014 Jan 1;80(1):43-47.
Joseph, Bellal ; Sadoun, Moutamn ; Aziz, Hassan ; Tang, Andrew ; Wynne, Julie L. ; Pandit, Viraj ; Kulvatunyou, Narong ; OKeeffe, Terence ; Friese, Randall S. ; Rhee, Peter. / Repeat head computed tomography in anticoagulated traumatic brain injury patients : Still warranted. In: American Surgeon. 2014 ; Vol. 80, No. 1. pp. 43-47.
@article{96ec6c5015af4093b2522476eb53ad6a,
title = "Repeat head computed tomography in anticoagulated traumatic brain injury patients: Still warranted",
abstract = "Anticoagulation agents are proven risk factors for intracranial hemorrhage (ICH) in traumatic brain injury (TBI). The aim of our study is to describe the epidemiology of prehospital coumadin, aspirin, and Plavix (CAP) patients with ICH and evaluate the use of repeat head computed tomography (CT) in this group. We performed a retrospective study from our trauma registry. All patients with intracranial hemorrhage on initial CTwith prehospital CAP therapy were included. Demographics, CT scan findings, number of repeat CT scans, progressive findings, and neurosurgical intervention were abstracted. A comparison between prehospital CAP and no-CAP patients was done using x2 and Mann-Whitney U test. A total of 1606 patients with blunt TBI charts were reviewed of whom 508 patients had intracranial bleeding on initial CT scan and 72 were on prehospital CAP therapy. CAP patients were older (P\0.001), had higher Injury Severity Score and head Abbreviated Injury Scores on admission (P\0.001), were more likely to present with an abnormal neurologic examination (P 5 0.004), and had higher hospital and intensive care unit lengths of stay (P\0.005). Eighty-four per cent of patients were on antiplatelet therapy and 27 per cent were on warfarin. The CAP patients have a threefold increase in the rate of worsening repeat head CT (26 vs 9{\%}, P\0.05). Prehospital CAP therapy is high risk for progression of bleeding on repeat head CT. Routine repeat head CT remains an important component in this patient population and can provide useful information.",
author = "Bellal Joseph and Moutamn Sadoun and Hassan Aziz and Andrew Tang and Wynne, {Julie L.} and Viraj Pandit and Narong Kulvatunyou and Terence OKeeffe and Friese, {Randall S.} and Peter Rhee",
year = "2014",
month = "1",
day = "1",
language = "English (US)",
volume = "80",
pages = "43--47",
journal = "Handbook of Behavioral Neuroscience",
issn = "0003-1348",
publisher = "JAI Press",
number = "1",

}

TY - JOUR

T1 - Repeat head computed tomography in anticoagulated traumatic brain injury patients

T2 - Still warranted

AU - Joseph, Bellal

AU - Sadoun, Moutamn

AU - Aziz, Hassan

AU - Tang, Andrew

AU - Wynne, Julie L.

AU - Pandit, Viraj

AU - Kulvatunyou, Narong

AU - OKeeffe, Terence

AU - Friese, Randall S.

AU - Rhee, Peter

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Anticoagulation agents are proven risk factors for intracranial hemorrhage (ICH) in traumatic brain injury (TBI). The aim of our study is to describe the epidemiology of prehospital coumadin, aspirin, and Plavix (CAP) patients with ICH and evaluate the use of repeat head computed tomography (CT) in this group. We performed a retrospective study from our trauma registry. All patients with intracranial hemorrhage on initial CTwith prehospital CAP therapy were included. Demographics, CT scan findings, number of repeat CT scans, progressive findings, and neurosurgical intervention were abstracted. A comparison between prehospital CAP and no-CAP patients was done using x2 and Mann-Whitney U test. A total of 1606 patients with blunt TBI charts were reviewed of whom 508 patients had intracranial bleeding on initial CT scan and 72 were on prehospital CAP therapy. CAP patients were older (P\0.001), had higher Injury Severity Score and head Abbreviated Injury Scores on admission (P\0.001), were more likely to present with an abnormal neurologic examination (P 5 0.004), and had higher hospital and intensive care unit lengths of stay (P\0.005). Eighty-four per cent of patients were on antiplatelet therapy and 27 per cent were on warfarin. The CAP patients have a threefold increase in the rate of worsening repeat head CT (26 vs 9%, P\0.05). Prehospital CAP therapy is high risk for progression of bleeding on repeat head CT. Routine repeat head CT remains an important component in this patient population and can provide useful information.

AB - Anticoagulation agents are proven risk factors for intracranial hemorrhage (ICH) in traumatic brain injury (TBI). The aim of our study is to describe the epidemiology of prehospital coumadin, aspirin, and Plavix (CAP) patients with ICH and evaluate the use of repeat head computed tomography (CT) in this group. We performed a retrospective study from our trauma registry. All patients with intracranial hemorrhage on initial CTwith prehospital CAP therapy were included. Demographics, CT scan findings, number of repeat CT scans, progressive findings, and neurosurgical intervention were abstracted. A comparison between prehospital CAP and no-CAP patients was done using x2 and Mann-Whitney U test. A total of 1606 patients with blunt TBI charts were reviewed of whom 508 patients had intracranial bleeding on initial CT scan and 72 were on prehospital CAP therapy. CAP patients were older (P\0.001), had higher Injury Severity Score and head Abbreviated Injury Scores on admission (P\0.001), were more likely to present with an abnormal neurologic examination (P 5 0.004), and had higher hospital and intensive care unit lengths of stay (P\0.005). Eighty-four per cent of patients were on antiplatelet therapy and 27 per cent were on warfarin. The CAP patients have a threefold increase in the rate of worsening repeat head CT (26 vs 9%, P\0.05). Prehospital CAP therapy is high risk for progression of bleeding on repeat head CT. Routine repeat head CT remains an important component in this patient population and can provide useful information.

UR - http://www.scopus.com/inward/record.url?scp=84894839224&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84894839224&partnerID=8YFLogxK

M3 - Article

C2 - 24401514

AN - SCOPUS:84894839224

VL - 80

SP - 43

EP - 47

JO - Handbook of Behavioral Neuroscience

JF - Handbook of Behavioral Neuroscience

SN - 0003-1348

IS - 1

ER -