Department of Emergency Medicine, Sheba Medical Center, Ramat-Gan, Israel; Tel Aviv University, Faculty of Medical & Health Sciences, Tel Aviv, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Department of Emergency Medicine, Sheba Medical Center, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Am J Emerg Med. 2024 Oct;84:93-97. doi: 10.1016/j.ajem.2024.07.049. Epub 2024 Jul 31.
Mild traumatic brain injuries (mTBIs) pose a significant risk, particularly in the elderly population on anticoagulation therapy. The safety of discharging these patients from the emergency department (ED) with a negative initial computed tomography (CT) scan has been debated due to the risk of delayed intracranial hemorrhage (d-ICH).
To compare outcomes, including d-ICH, between elderly patients on anticoagulation therapy presenting with mTBI who were admitted versus discharged from the ED after an initial negative head CT scan.
We conducted a retrospective observational study at the Chaim Sheba Medical Center, assessing outcomes of 1598 elderly patients on anticoagulation therapy who presented with mTBI and an initial negative head CT scan. Patients were either admitted for 24-h observation (Group A, n = 829) or discharged immediately from the ED (Group B, n = 769). The primary outcome was incidence of d-ICH within 14 days.
Among the 1598 patients included in the study, 46 admitted patients and 1 discharged patient returned within 14 days for repeat CT, identifying one asymptomatic hemorrhage in the discharged patient. Mortality at 30 days was significantly higher in admitted patients compared to discharged patients (4.8% vs. 1.8%, p = 0.001), though cause of death was unrelated to head injury in both groups.
In elderly patients on anticoagulation with mTBI and a negative initial CT, admission was associated with a higher risk of d-ICH compared to discharge. These findings have implications for clinical decision-making in this high-risk population.
轻度创伤性脑损伤（mTBI）风险较大，尤其在接受抗凝治疗的老年人群中。由于存在迟发性颅内出血（d-ICH）的风险，对于这些患者在急诊（ED）进行初始计算机断层扫描（CT）检查阴性后出院的安全性存在争议。
比较接受抗凝治疗的 mTBI 老年患者的结局，包括 d-ICH，这些患者在初始头部 CT 扫描阴性后，分别在 ED 接受住院观察和直接出院。
我们在 Chaim Sheba 医疗中心进行了一项回顾性观察性研究，评估了 1598 名接受抗凝治疗且有 mTBI 且初始头部 CT 扫描阴性的老年患者的结局。患者要么在 24 小时内接受观察治疗（A 组，n=829），要么直接从 ED 出院（B 组，n=769）。主要结局为 14 天内 d-ICH 的发生率。
在纳入的 1598 例患者中，46 例住院患者和 1 例出院患者在 14 天内返回接受重复 CT，发现出院患者中有 1 例无症状性出血。与出院患者相比，30 天死亡率在住院患者中显著更高（4.8% vs. 1.8%，p=0.001），但两组患者的死亡原因均与头部损伤无关。
对于接受抗凝治疗且有 mTBI 且初始 CT 阴性的老年患者，与出院相比，住院与 d-ICH 的风险增加相关。这些发现对这一高风险人群的临床决策具有重要意义。
