Thier Zachary T, Drake-Lavelle Kelan, Prest Phillip J, Jones Mark A, Reeves Jeremy M, McClung-Smith Catherine F, Goodwin Tyler M, Villani Nolan, Metz John, Jackson J Benjamin
219270Lincoln Memorial University DeBusk College of Osteopathic Medicine, Knoxville, TN, USA.
Department of Orthopaedic Surgery, 12322University of South Carolina School of Medicine, Columbia, SC, USA.
Am Surg. 2022 May;88(5):894-900. doi: 10.1177/00031348211054078. Epub 2021 Nov 18.
Chemical prophylaxis using low-molecular-weight heparin (LMWH) is considered a standard of care for venous thromboembolism in trauma patients. Our center performs a head computed tomography (CT) scan 24 hours after initiation with prophylactic LMWH in the setting of a known traumatic brain injury (TBI). The purpose was to determine the overall incidence of ICH progression after chemoprophylaxis in patients with a TBI.
This retrospective study was performed at a Level I trauma center, from 1/1/2014 to 12/31/2017. Study patients were drawn from the institution's trauma registry based on Abbreviated Injury Score codes.
778 patients met all inclusion criteria after initial chart review. The proportion of patients with an observed radiographic progression of intracranial hemorrhage after LMWH was 5.8%. 3.1% of patients had a change in clinical management. Observed radiographic progression after LMWH prophylaxis and the presence of SDH on initial CT, the bilateral absence of pupillary response in the emergency department, and a diagnosis of dementia were found to have statistically significant correlation with bleed progression after LMWH was initiated.
Over a 4-year period, the use of CT to evaluate for radiographic progression of traumatic intracranial hemorrhage 24 hours after receiving LMWH resulted in a change in clinical management for 3.1% of patients. The odds of intracranial hemorrhage progression were approximately 6.5× greater in patients with subdural hemorrhage on initial CT, 3.1× greater in patients with lack of bilateral pupillary response in ED, and 4.2× greater in patients who had been diagnosed with dementia.
使用低分子量肝素（LMWH）进行化学预防被认为是创伤患者静脉血栓栓塞症的标准治疗方法。在已知创伤性脑损伤（TBI）的情况下，我们中心在开始预防性使用LMWH 24小时后进行头部计算机断层扫描（CT）。目的是确定TBI患者化学预防后颅内出血（ICH）进展的总体发生率。
这项回顾性研究在一级创伤中心进行，时间为2014年1月1日至2017年12月31日。研究患者是根据简明损伤评分代码从该机构的创伤登记处抽取的。
在初步病历审查后，778名患者符合所有纳入标准。LMWH后观察到颅内出血影像学进展的患者比例为5.8%。3.1%的患者临床管理发生了变化。发现LMWH预防后观察到的影像学进展、初始CT上存在硬膜下血肿（SDH）、急诊科双侧瞳孔反应缺失以及痴呆诊断与开始使用LMWH后的出血进展具有统计学显著相关性。
在4年期间，使用CT评估接受LMWH 24小时后创伤性颅内出血的影像学进展，导致3.1%的患者临床管理发生变化。初始CT有硬膜下出血的患者颅内出血进展的几率大约高6.5倍，急诊科双侧瞳孔反应缺失的患者高3.1倍，诊断为痴呆的患者高4.2倍。
