HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan

Pedro Duarte-Batista, Nuno Cubas Farinha, Renata Marques, João Páscoa Pinheiro, João Silva, Rui Tuna, José Hipólito Reis, Cristiano Antunes, Maria João Machado, Samuel Sequeira Lemos, Jessica Branco, Diogo Roque, Diogo Simão, Nuno Simas, Wilson Teixeira, Cátia Felício, Miguel Ferreira, Eduardo Cunha, Luís Rocha, Gonçalo Figueiredo, Carolina Noronha, Vasco Pinto, Filipe Silva, Ana Ferreira, Osvaldo Sousa

Abstract


Introduction: Our national protocol for traumatic brain injury dictates that hypocoagulated patients with mild trauma and initial tomography scan with no intracranial traumatic changes must be hospitalized for 24 hours and do a post-surveillance tomography scan. The main goal of this study was to evaluate the clinical relevance of these measures.
Material and Methods: A prospective observational study was undertaken in four hospitals. Adult hypocoagulated traumatic brain injury patients with a normal tomography scan were included. The main outcomes evaluated were rate of delayed intracranial hemorrhage, rate of admission in a neurosurgical department, rate of complications related with surveillance and rate of prolonged hospitalization due to complications. An analysis combining data from a previously published report was also done.
Results: A total of 178 patients were included. Four patients (2.3%) had a delayed hemorrhage and three (1.7%) were hospitalized in a neurosurgery ward. No cases of symptomatic hemorrhage were identified. No surgery was needed, and all patients had their anticoagulation stopped. Complications during surveillance were reported in seven patients (3.9%), of which two required prolonged hospitalization.
Discussion: The rate of complications related with surveillance was higher than the rate of delayed hemorrhages. The initial period of in-hospital surveillance did not convey any advantage since the management of patients was never dictated by neurological changes. Post-surveillance tomography played a role in deciding about anticoagulation suspension and prolongation of hospitalization.
Conclusion: Delayed hemorrhage is a rare event and the need for surgery even rarer. The need for in-hospital surveillance should be reassessed.


Keywords


Anticoagulants; Brain Injuries, Traumatic; Intracranial Hemorrhage, Traumatic; Multicenter Study; Neurosurgical Procedures; Tomography, Spiral Computed

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