Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH, USA.
Department of Pulmonology and Critical Care, University of Pittsburgh Medical Center Hamot, PA, USA.
Am J Emerg Med. 2021 Sep;47:6-12. doi: 10.1016/j.ajem.2021.03.035. Epub 2021 Mar 13.
Antithrombotic-associated subdural hematomas (SDHs) are increasingly common, and the possibility of clinical deterioration in otherwise stable antithrombotic-associated SDH patients may prompt unnecessary admissions to intensive care units. It is unknown whether all antithrombotic regimens are equally associated with the need for critical care interventions. We sought to compare the frequency of critical care interventions and poor functional outcomes among three cohorts of noncomatose SDH patients: patients on no antithrombotics, patients on anticoagulants, and patients on antiplatelets alone.
We performed a retrospective cohort study on all noncomatose SDH patients (Glasgow Coma Scale > 12) presenting to an academic health system in 2018. The three groups of patients were compared in terms of clinical course and functional outcome. Multivariable logistic regression was used to determine predictors of need for critical care interventions and poor functional outcome at hospital discharge.
There were 281 eligible patients presenting with SDHs in 2018, with 126 (45%) patients on no antithrombotics, 106 (38%) patients on antiplatelet medications alone, and 49 (17%) patients on anticoagulants. Significant predictors of critical care interventions were coagulopathy (OR 5.1, P < 0.001), presence of contusions (OR 3, P = 0.007), midline shift (OR 3.4, P = 0.002), and maximum SDH thickness (OR 2.4, P = 0.002). Significant predictors of poor functional outcome were age (OR 1.8, P < 0.001), admission Glasgow Coma Scale score (OR 0.3, P < 0.001), dementia history (OR 4.2, P = 0.001), and coagulopathy (OR 3.5, P = 0.02). Isolated antiplatelet use was not associated with either critical care interventions or functional outcome.
Isolated antiplatelet use is not a significant predictor of need for critical care interventions or poor functional outcome among SDH patients and should not be used as a criterion for triage to the intensive care unit.
抗血栓治疗相关的硬膜下血肿（SDH）越来越常见，对于原本稳定的抗血栓治疗相关 SDH 患者，其临床恶化的可能性可能促使不必要地收入重症监护病房。目前尚不清楚所有抗血栓治疗方案是否都与需要重症监护干预同等相关。我们旨在比较三组非昏迷性 SDH 患者（格拉斯哥昏迷评分> 12）的重症监护干预和不良功能结局的频率：未使用抗血栓药物的患者、使用抗凝药物的患者和仅使用抗血小板药物的患者。
我们对 2018 年在一家学术医疗机构就诊的所有非昏迷性 SDH 患者（格拉斯哥昏迷评分> 12）进行了回顾性队列研究。比较了三组患者的临床病程和功能结局。多变量逻辑回归用于确定需要重症监护干预和出院时不良功能结局的预测因素。
2018 年有 281 名符合条件的 SDH 患者，其中 126 名（45%）患者未使用抗血栓药物，106 名（38%）患者仅使用抗血小板药物，49 名（17%）患者使用抗凝药物。重症监护干预的显著预测因素包括凝血障碍（OR 5.1，P < 0.001）、挫伤存在（OR 3，P = 0.007）、中线移位（OR 3.4，P = 0.002）和最大 SDH 厚度（OR 2.4，P = 0.002）。不良功能结局的显著预测因素包括年龄（OR 1.8，P < 0.001）、入院格拉斯哥昏迷评分（OR 0.3，P < 0.001）、痴呆病史（OR 4.2，P = 0.001）和凝血障碍（OR 3.5，P = 0.02）。单独使用抗血小板药物与重症监护干预或 SDH 患者的功能结局无关。
单独使用抗血小板药物不是 SDH 患者需要重症监护干预或不良功能结局的显著预测因素，不应作为将患者分诊至重症监护病房的标准。
