Department of Surgery, Lehigh Valley Health Network, Allentown, PA, USA.
J Trauma Acute Care Surg. 2012 Jul;73(1):126-30. doi: 10.1097/TA.0b013e31824b01af.
Of the 500,000 brain injuries in the United States annually, 80% are considered mild (mild traumatic brain injury). Unfortunately, 2% to 3% of them will subsequently deteriorate and result in severe neurologic dysfunction. Intracerebral changes in the elderly, chronic oral anticoagulation, and platelet inhibition may contribute to the development of intracranial bleeding after minor head injury. We sought to investigate the association of age and the use of anticoagulation and antiplatelet therapy with neurologic deterioration and the need for neurosurgical intervention in patients presenting with mild traumatic brain injury.
A retrospective review of all adult (>14 years) patients admitted to our Level I trauma service with a Glasgow Coma Scale (GCS) score of 14 to 15 who underwent neurosurgical intervention during their hospital stay was performed. Patients were stratified into two groups, age <65 years and age ≥ 65 years. Each group was then further stratified by the use of anticoagulants: warfarin, aspirin, clopidogrel, or a combination. Mechanism of injury, prehospital complaints, admission GCS, type of neurosurgical intervention, intensive care unit length of stay, hospital length of stay, and discharge disposition were evaluated. Z test and logistic regression were used to compare proportions or percentages from different groups.
Of the 7,678 patients evaluated during the study period, 101 (1.3%) required neurosurgical intervention. The ≥ 65 years population underwent significantly more interventions as did those patients on anticoagulants.
All patients aged 65 years or older who present with a GCS score of >13 after head trauma should undergo a screening computed tomography of the head regardless of prehospital use of anticoagulation. Patients younger than 65 years can be selectively screened based on presenting complaints and mechanism of injury provided they are not on anticoagulation.
在美国每年发生的 50 万例脑损伤中，80%被认为是轻度脑损伤（轻度创伤性脑损伤）。不幸的是，其中 2%至 3%会随后恶化并导致严重的神经功能障碍。老年人的颅内变化、慢性口服抗凝和血小板抑制可能导致轻微头部损伤后颅内出血的发展。我们试图研究年龄以及抗凝和抗血小板治疗的使用与神经恶化以及轻度创伤性脑损伤患者需要神经外科干预的关系。
对在我院接受治疗的格拉斯哥昏迷量表（GCS）评分为 14-15 分且在住院期间接受神经外科干预的所有>14 岁（成年）患者进行回顾性研究。患者分为年龄<65 岁和年龄≥65 岁两组。然后，根据抗凝剂的使用情况，将每组进一步分为华法林、阿司匹林、氯吡格雷或联合使用的亚组。评估了损伤机制、院前主诉、入院时 GCS、神经外科干预类型、重症监护病房住院时间、住院时间和出院处置。使用 Z 检验和逻辑回归比较来自不同组的比例或百分比。
在所研究的 7678 例患者中，有 101 例（1.3%）需要神经外科干预。≥65 岁人群接受干预的比例明显更高，且使用抗凝剂的患者也更多。
所有年龄≥65 岁且头部创伤后 GCS 评分>13 的患者，无论院前是否使用抗凝剂，均应行头颅 CT 筛查。年龄<65 岁的患者，如果没有使用抗凝剂，可以根据主诉和损伤机制选择性地进行筛查。
