Mann Nolan, Welch Kellen, Martin Andrew, Subichin Michael, Wietecha Katherine, Birmingham Lauren E, Marchand Tiffany D, George Richard L
Summa Health System- Department of Surgery, Akron Campus, Akron, OH, USA.
Summa Health System- Department of Surgery, Division of Trauma Akron Campus, Akron Ohio, USA Northeast Ohio Medical University, Rootstown, OH, USA.
BMC Emerg Med. 2018 Aug 24;18(1):27. doi: 10.1186/s12873-018-0179-0.
Falls are a common cause of hospitalization, morbidity, and mortality among the elderly in the United States. Evidence-based imaging recommendations for evaluation of delayed intracranial hemorrhage (DICH) are not generally agreed upon. The purpose of this project was to evaluate the incidence of DICH detected by head computer tomography (CT) among an elderly population on pre-injury anticoagulant or antiplatelet (ACAP) therapy.
Data from a Level 1 Trauma Center trauma registry was used to assess the incidence of DICH in an elderly population of patients (≥65 years) who sustained a minor fall while on pre-injury ACAP medications. Counts and percentages are reported.
Data on 1076 elderly trauma patients were downloaded, of which 838 sustained a minor fall and 513 were found to be using a pre-injury ACAP medication. One patient (0.46%) with a DICH was identified out of 218 patients who received a routine repeat head CT. Aspirin and warfarin were the most common pre-injury ACAP medications and 19.27% (42/218) of patients were found to be using multiple ACAP medications.
Universal screening protocols promote immediate-term patient safety, but do so at a great expense with respect to health expenditures and increased radiation exposure. This analysis highlights the need for an effective risk assessment tool for DICH that would reduce the burden of unnecessary screenings while still identifying life-threatening intracranial hemorrhages in affected patients.
在美国，跌倒 是老年人住院、发病和死亡的常见原因。关于评估迟发性颅内出血（DICH）的循证影像学建议尚未得到普遍认可。本项目的目的是评估在受伤前接受抗凝或抗血小板（ACAP）治疗的老年人群中，通过头部计算机断层扫描（CT）检测到的 DICH 发生率。
来自一级创伤中心创伤登记处的数据用于评估在受伤前服用 ACAP 药物时发生轻微跌倒的老年患者（≥65 岁）中 DICH 的发生率。报告计数和百分比。
下载了 1076 名老年创伤患者的数据，其中 838 人发生轻微跌倒，513 人被发现受伤前正在服用 ACAP 药物。在 218 名接受常规重复头部 CT 检查的患者中，发现 1 例（0.46%）患有 DICH。阿司匹林和华法林是最常见的受伤前 ACAP 药物，19.27%（42/218）的患者被发现使用多种 ACAP 药物。
通用筛查方案可促进近期患者安全，但在医疗费用和增加辐射暴露方面成本高昂。该分析强调需要一种有效的 DICH 风险评估工具，以减轻不必要筛查的负担，同时仍能识别受影响患者中危及生命的颅内出血。
