Antiplatelet Agent Reversal Is Unnecessary in Blunt Traumatic Brain Injury Patients Not Requiring Immediate Craniotomy

2020 ◽  
Vol 86 (7) ◽  
pp. 826-829
Author(s):  
Kojo Agyabeng-Dadzie ◽  
Jocelyn E. Hunter ◽  
Timothy R. Smith ◽  
Monica Jordan ◽  
Karen Safcsak ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Antiplatelet Therapy ◽  
Platelet Transfusion ◽  
Injury Severity ◽  
Antiplatelet Agent ◽  
Antiplatelet Agents ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Burr Holes

Background The need to reverse the coagulation impairment caused by chronic antiplatelet agents in traumatic brain injury (TBI) patients with acute traumatic intracerebral hemorrhage (TICH) remains controversial. We sought to determine whether emergent platelet transfusion reduces the incidence of hemorrhage expansion, mortality, or need for neurosurgical intervention such as intracranial pressure (ICP) monitoring, burr holes, or craniotomy. Methods All adult blunt TICH patients (age ≥16 years) over a 4-year period were retrospectively reviewed. Patients with penetrating TBI, blunt TBI without TICH on admission computed tomography (CT), receiving warfarin, not on antiplatelet agents, or requiring immediate operative intervention were excluded. Patients were divided into 2 groups depending on whether they received a platelet transfusion: reversal group (RV) versus no reversal group (NR). Patient outcomes were analyzed using Mann-Whitney U and Fisher’s exact tests. Results 169 blunt TBI patients on chronic antiplatelet therapy were studied (102 RV group, 67 NR group). The groups were well matched with regard to age, Injury Severity Score, Abbreviated Injury Scale-head, Glasgow Coma Score, mechanism of injury, need for intubation, time to initial CT scan, and hospital length of stay. Immediate platelet transfusion did not alter the occurrence of TICH extension on follow-up CT (26% vs 21%, P = .71), TBI-specific mortality (9% vs 13%, P = .45), need for ICP monitor (2% vs 3%, P = 1.0), burr hole (1% vs 3%, P = .56), or craniotomy (1% vs 3%, P = .56). Discussion Immediate platelet transfusion is unnecessary in blunt TBI patients on chronic antiplatelet therapy who do not require immediate craniotomy.

The Morbidity and Mortality of Surgery for Traumatic Brain Injury in Geriatric Patients: A Study of Over 100 000 Patient Cases

Neurosurgery ◽  
2021 ◽  
Author(s):  
Alexander F Haddad ◽  
Anthony M DiGiorgio ◽  
Young M Lee ◽  
Anthony T Lee ◽  
John F Burke ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Geriatric Patients ◽  
Injury Severity ◽  
Surgical Intervention ◽  
Recursive Partitioning ◽  
Data Bank ◽  
Hospital Length ◽  
Morbidity And Mortality ◽  
Hospital Length Of Stay

Abstract BACKGROUND Geriatric patients have the highest rates of Traumatic Brain Injury (TBI)-related hospitalization and death. This contributes to an assumption of futility in aggressive management in this population. OBJECTIVE To evaluate the effect of surgical intervention on the morbidity and mortality of geriatric patients with TBI. METHODS A retrospective analysis of patients ≥80 yr old with TBI from 2003 to 2016 was performed using the National Trauma Data Bank. Univariate and multivariate analyses were performed to compare outcomes between surgery and nonsurgery groups. RESULTS A total of 127 129 patient incidents were included: 121 185 (95.3%) without surgery and 5944 (4.7%) with surgery. The surgical group was slightly younger (84.0 vs 84.3, P < .001) and predominantly male (60.2% vs 44.4%, P < .001). Mean emergency department (ED) Glasgow Coma Scale (GCS) was lower in surgical patients (12.4 vs 13.7, P < .001). Complications (OR = 1.91, CI:1.80-2.02, P < .001) and hospital length of stay (LOS, ß = 5.25, CI:5.08-5.42, P < .001) were independently associated with surgery. Intensive care unit (ICU) LOS (ß = 3.19, CI:3.05-3.34, P < .001), ventilator days (ß = 1.57, CI:1.22-1.92, P < .001), and reduced discharge home (OR = 0.434, CI:0.400-0.470, P < .001) were also independently associated with surgery. However, surgery was not independently associated with mortality on multivariate analysis (OR = 1.03, CI:0.955-1.12, P = .423). Recursive partitioning analysis identified ED GCS and injury severity score (ISS) as prognosticators of mortality following surgical intervention. CONCLUSION Surgical treatment of geriatric patients with TBI is associated with increased complications, hospital LOS, ICU LOS, and ventilator days as well as reduced discharge to home. However, surgery is not associated with increased mortality. ISS and ED GCS are prognosticators of mortality following surgical intervention.

scholarly journals Recent trends in hospitalization and in-hospital mortality associated with traumatic brain injury in Canada: a nationwide, population-based study

2015 ◽  
Vol 42 (S1) ◽  
pp. S21-S21
Author(s):  
T Fu ◽  
R Jing ◽  
S McFaull ◽  
M Cusimano
Keyword(s):  
Traumatic Brain Injury ◽  
Young Adults ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Population Based ◽  
Hospital Length Of Stay ◽  
Elderly Adults ◽  
Hospitalization Rates

Background: Traumatic brain injury (TBI) is the leading cause of traumatic death and disability worldwide. We examined nationwide trends in TBI-related hospitalizations and in-hospital mortality between April 2006 and March 2010 using a population-based database that is mandatory for all hospitals in Canada. Methods: Trends in hospitalization rates were analyzed using linear regression. Independent predictors of in-hospital mortality were evaluated using logistic regression. Results: Hospitalization rates remained stable for children and young adults, but increased considerably among elderly adults (ages 65 and older). Falls and motor vehicle collisions (MVCs) were the most common causes of TBI hospitalizations. TBIs caused by falls increased by 24% (p=0.01), while MVC-related hospitalization rates decreased by 18% (p=0.03). Elderly adults were most vulnerable to falls, and experienced the greatest increase (29%) in fall-related hospitalization rates. Young adults (ages 15-24) were most at risk for MVCs, but experienced the greatest decline (28%) in MVC-related admissions. There were significant trends towards increasing age, injury severity, comorbidity, hospital length of stay, and in-hospital mortality. However, multivariate regression showed that the odds of death decreased over time after controlling for relevant factors. Conclusions: Hospitalizations for TBI are increasing in severity and involve older populations with more complex comorbidities.

Does Platelet Administration Affect Mortality in Elderly Head-Injured Patients Taking Antiplatelet Medications?

2009 ◽  
Vol 75 (11) ◽  
pp. 1100-1103 ◽  
Author(s):  
Douglas M. Downey ◽  
Benjamin Monson ◽  
Karyn L. Butler ◽  
Gerald R. Fortuna ◽  
Jonathan M. Saxe ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Platelet Transfusion ◽  
Injury Severity ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Head Injured ◽  
Outcome Differences ◽  
Level I ◽  
Injured Patients

A significant portion of patients sustaining traumatic brain injury (TBI) take antiplatelet medications (aspirin or clopidogrel), which have been associated with increased morbidity and mortality. In an attempt to alleviate the risk of increased bleeding, platelet transfusion has become standard practice in some institutions. This study was designed to determine if platelet transfusion reduces mortality in patients with TBI on antiplatelet medications. Databases from two Level I trauma centers were reviewed. Patients with TBI 50 years of age or older with documented preinjury use of clopidogrel or aspirin were included in our cohort. Patients who received platelet transfusions were compared with those who did not to assess outcome differences between them. Demographics and other patient characteristics abstracted included Injury Severity Score, Glasgow Coma Scale, hospital length of stay, and warfarin use. Three hundred twenty-eight patients comprised the study group. Of these patients, 166 received platelet transfusion and 162 patients did not. Patients who received platelets had a mortality rate of 17.5 per cent (29 of 166), whereas those who did not receive platelets had a mortality rate of 16.7 per cent (27 of 162) ( P = 0.85). Transfusion of platelets in patients with TBI using antiplatelet therapy did not reduce mortality.

scholarly journals Prehospital Intubation in Patients with Isolated Severe Traumatic Brain Injury: A 4-Year Observational Study

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Mazin Tuma ◽  
Ayman El-Menyar ◽  
Husham Abdelrahman ◽  
Hassan Al-Thani ◽  
Ahmad Zarour ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Length Of Stay ◽  
Severe Traumatic Brain Injury ◽  
Multivariate Regression Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Resuscitation ◽  
Initial Blood ◽  
Initial Blood Pressure

Objectives. To study the effect of prehospital intubation (PHI) on survival of patients with isolated severe traumatic brain injury (ISTBI).Method. Retrospective analyses of all intubated patients with ISTBI between 2008 and 2011 were studied. Comparison was made between those who were intubated in the PHI versus in the trauma resuscitation unit (TRU).Results. Among 1665 TBI patients, 160 met the inclusion criteria (105 underwent PHI, and 55 patients were intubated in TRU). PHI group was younger in age and had lower median scene motor GCS (P=0.001). Ventilator days and hospital length of stay (P=0.01and 0.006, resp.) were higher in TRUI group. Mean ISS, length of stay, initial blood pressure, pneumonia, and ARDS were comparable among the two groups. Mortality rate was higher in the PHI group (54% versus 31%,P=0.005). On multivariate regression analysis, scene motor GCS (OR 0.55; 95% CI 0.41–0.73) was an independent predictor for mortality.Conclusion. PHI did not offer survival benefit in our group of patients with ISTBI based on the head AIS and the scene motor GCS. However, more studies are warranted to prove this finding and identify patients who may benefit from this intervention.

scholarly journals Multicenter assessment of the Brain Injury Guidelines and a proposal of guideline modifications

2020 ◽  
Vol 5 (1) ◽  
pp. e000483 ◽  
Author(s):  
Abid D Khan ◽  
Anna J Elseth ◽  
Jacqueline A Brosius ◽  
Eliza Moskowitz ◽  
Sean C Liebscher ◽  
...  
Keyword(s):  
Patient Safety ◽  
Brain Injury ◽  
Length Of Stay ◽  
Resource Utilization ◽  
Injury Severity ◽  
Improve Patient Safety ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Head Ct ◽  
The Brain

BackgroundThe Brain Injury Guidelines provide an algorithm fortreating patients with traumatic brain injury (TBI) and intracranial hemorrhage(ICH) that does not mandate hospital admission, repeat head CT, orneurosurgical consult for all patients. The purposes of this study are toreview the guidelines’ safety, to assess resource utilization, and to proposeguideline modifications that improve patient safety and widespreadreproducibility.MethodsA multi-institutional review of TBI patients was conducted. Patients with ICH on CT were classified as BIG 1, 2, or 3 based on the guidelines. BIG 3 patients were excluded. Variables collected included demographics, Injury Severity Score (ISS), hospital length of stay (LOS), intensive care unit LOS, number of head CTs, type of injury, progression of injury, and neurosurgical interventions performed.Results269 patients met inclusion criteria. 98 were classifiedas BIG 1 and 171 as BIG 2. The median length of stay (LOS) was 2 (2,4)days and the ICU LOS was 1 (0,2) days. Most patients had a neurosurgeryconsultation (95.9%) and all patients included had a repeat head CT. 370repeat head CT scans were performed, representing 1.38 repeat scans perpatient. 11.2% of BIG 1 and 11.1% of BIG 2 patients demonstratedworsening on repeat head CT. Patients who progressed exhibited a higherISS (14 vs. 10, p=0.040), and had a longer length of stay (4 vs. 2 days;p=0.015). After adjusting for other variables, the presence of epiduralhematoma (EDH) and intraparenchymal hematoma were independent predictors ofprogression. Two BIG 2 patients with EDH had clinical deteriorationrequiring intervention.DiscussionThe Brain Injury Guidelines may improve resourceallocation if utilized, but alterations are required to ensure patientsafety. The modified Brain Injury Guidelines refine the originalguidelines to enhance reproducibility and patient safety while continuing toprovide improved resource utilization in TBI management.

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