Citation

Turcato G, Zaboli A, Zannoni M, Ricci G, Zorzi E, Ciccariello L, Tenci A, Pfeifer N, Maccagnani A, Bonora A. Am. J. Emerg. Med. 2020; ePub(ePub): ePub.

Affiliation

Department of Emergency Medicine, University of Verona, Verona, Italy.

Copyright

(Copyright © 2020, Elsevier Publishing)

DOI

10.1016/j.ajem.2020.02.046

PMID

32122712

Abstract

BACKGROUND: The established clinical risk factors for post-traumatic intracranial bleeding have not been evaluated in patients receiving DOACs yet.

AIM: Evaluating the association between clinic and patient characteristics and post-traumatic intracranial bleeding (ICH) in patients with mild traumatic brain injury (MTBI) and DOACs.

METHODS: This is a retrospective observational study conducted on three Emergency Departments. Multivariate analysis provided association in terms of OR with the risk of ICH. The performance of the multivariate model, described in a nomogram, has been tested with discrimination and decision curve analysis.

RESULTS: Of 473 DOACs patients with MTBI, 8.5% had post-traumatic ICH. On multivariable analysis, major dynamics (odds ratio [OR] 6.255), post-traumatic amnesia (OR 3.961), post-traumatic loss of consciousness (LOC, OR 7.353), Glasgow Coma Scale (GCS) score < 15 (OR 3.315), post-traumatic headache (OR 4.168) and visible trauma above the clavicles (OR 3.378) were associated with a higher likelihood of ICH. The multivariate model, used for the nomogram construction, showed a good performance (AUC bias corrected with 5000 bootstraps resample 0.78). The DCAs showed a net clinical benefit of the prognostic model.

CONCLUSIONS: Clinical risk factors can be used in DOACs patients to better define the risk of post-traumatic ICH.

Copyright © 2020 Elsevier Inc. All rights reserved.

Language: en

Keywords

Decision curve analysis; Direct oral anticoagulants; Mild traumatic brain injury; Nomogram; Post-traumatic intracranial haemorrhage; Risk factors