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{
    "pk": 7969,
    "title": "Routine Repeat Head CT may not be Indicated in  Patients on Anticoagulant/Antiplatelet Therapy  Following Mild Traumatic Brain Injury",
    "subtitle": null,
    "abstract": "Introduction: \nEvaluation recommendations for patients on anticoagulant and antiplatelet (ACAP) therapy that present after mild traumatic brain injury (TBI) are controversial. At our institution, an initial noncontrast head computed tomography (HCT) is performed, with a subsequent HCT performed six hours later to exclude delayed intracranial hemorrhage (ICH). This study was performed to evaluate the yield and advisability of this approach.\nMethods: \nWe performed a retrospective review of subjects undergoing evaluation for ICH after mild TBI in patients on ACAP therapy between January of 2012 and April of 2013. We assessed for the frequency of ICH on both the initial noncontrast HCT and on the routine six-hour follow-up HCT. Additionally, chart review was performed to evaluate the clinical implications of ICH, when present, and to interrogate whether pertinent clinical and laboratory data may predict the presence of ICH prior to imaging. We used multivariate generalized linear models to assess whether presenting Glasgow Coma Score (GCS), loss of consciousness (LOC), neurological or physical examination findings, international normalized ratio, prothrombin time, partial thromboplastin time, platelet count, or specific ACAP regimen predicted ICH.\nResults: \n144 patients satisfied inclusion criteria. Ten patients demonstrated initial HCT positive for ICH, with only one demonstrating delayed ICH on the six-hour follow-up HCT. This patient was discharged without any intervention required or functional impairment. Presenting GCS deviation (p<0.001), LOC (p=0.04), neurological examination findings (p<0.001), clopidogrel (p=0.003), aspirin (p=0.03) or combination regimen (p=0.004) use were more commonly seen in patients with ICH.\nConclusion: \nRoutine six-hour follow-up HCT is likely not indicated in patients on ACAP therapy, as our study suggests clinically significant delayed ICH does not occur. Additionally, presenting GCS deviation, LOC, neurological examination findings, clopidogrel, aspirin or combination regimen use may predict ICH, and, in the absence of these findings, HCT may potentially be forgone altogether. [West J Emerg Med. 2015;16(1):-0.]",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "anticoagulation"
        },
        {
            "word": "antiplatelet"
        },
        {
            "word": "Mild traumatic brain injury"
        },
        {
            "word": "head computed tomography"
        },
        {
            "word": "intracranial hemorrhage"
        }
    ],
    "section": "Health Outcomes",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/4qf8r53t",
    "frozenauthors": [
        {
            "first_name": "Kevin",
            "middle_name": "C.",
            "last_name": "McCammack",
            "name_suffix": "",
            "institution": "University of California, San Diego, Department of Radiology, San Diego, California",
            "department": "None"
        },
        {
            "first_name": "Charlotte",
            "middle_name": "",
            "last_name": "Sadler",
            "name_suffix": "",
            "institution": "University of California, San Diego, Department of Emergency Medicine, San Diego, California",
            "department": "None"
        },
        {
            "first_name": "Yueyang",
            "middle_name": "",
            "last_name": "Guo",
            "name_suffix": "",
            "institution": "University of California, San Diego, Department of Radiology, San Diego, California; University of California, San Diego, School of Medicine, San Diego, California",
            "department": "None"
        },
        {
            "first_name": "Raja",
            "middle_name": "S",
            "last_name": "Ramaswamy",
            "name_suffix": "",
            "institution": "University of California, San Diego, Department of Radiology, San Diego, California",
            "department": "None"
        },
        {
            "first_name": "Nikdokht",
            "middle_name": "",
            "last_name": "Farid",
            "name_suffix": "",
            "institution": "University of California, San Diego, Department of Radiology, San Diego, California",
            "department": "None"
        }
    ],
    "date_submitted": "2013-09-06T16:33:33Z",
    "date_accepted": "2013-09-06T16:33:33Z",
    "date_published": "2014-12-01T20:36:34Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/7969/galley/4619/download/"
        }
    ]
}