Jaffres Emma, Dacher Jean-Nicolas, Taalba Mehdi, Roca Frédéric, Garnier Matthieu, Normant Sébastien, Lozouet Mathieu, Gérardin Emmanuel, Burel Julien
Department of Radiology, Centre Hospitalier Universitaire de Rouen, Rouen, France.
Department of Emergency Medicine, Centre Hospitalier Universitaire de Rouen, Rouen, France.
Res Diagn Interv Imaging. 2025 Jan 16;13:100053. doi: 10.1016/j.redii.2024.100053. eCollection 2025 Mar.
Recent literature suggests that performing systematic head computed tomography (CT) scans for mild traumatic brain injury (mTBI) in patients undergoing antithrombotic therapy offers limited benefits. This study aims to evaluate a set of criteria that could potentially eliminate the need for systematic head CT scans, performed solely because of the antithrombotic treatment status, in elderly patients (aged 75 or older) presenting with mTBI.
All patients aged 75 or older who underwent a head CT scan at our academic center for mTBI while on antithrombotic therapy between January and December 2022 were retrospectively included in this study. Patients were categorized into two groups. The first group, referred to as the "At-risk group", included patients with any of the following: GCS score < 15 or cognitive impairment; initial loss of consciousness; hemodynamic instability; signs of fractures; extensive subcutaneous hematoma; severe or treatment-resistant headache; vomiting; seizure; any neurological deficit; intoxication; amnesia; or a history of neurosurgery. The second group, referred to as the "Not-at-risk group", comprised patients without any of these criteria.
A total of 1415 patients were included. Post-traumatic intracranial hemorrhage ( < 0.001), brain herniation ( = 0.003), and fractures ( < 0.001) occurred statistically more frequently in the At-risk group. Six post-traumatic hemorrhagic brain injuries were found in the Not-at-risk group, that did not present any of the studied criteria, and all these injuries were minor (localized SAH; millimetric SDH). Furthermore, none of these required immediate or delayed surgical intervention, and no neurological deterioration or deaths occurred in these patients.
In conclusion, conducting systematic head CT scans based solely on antithrombotic therapy in elderly patients aged 75 or older with mTBI might be irrelevant.
近期文献表明，对接受抗血栓治疗的轻度创伤性脑损伤（mTBI）患者进行系统性头部计算机断层扫描（CT）的益处有限。本研究旨在评估一套标准，该标准可能消除在患有mTBI的老年患者（75岁及以上）中仅因抗血栓治疗状态而进行系统性头部CT扫描的必要性。
回顾性纳入2022年1月至12月期间在我们学术中心因mTBI接受抗血栓治疗时进行头部CT扫描的所有75岁及以上患者。患者分为两组。第一组称为“风险组”，包括具有以下任何一种情况的患者：格拉斯哥昏迷量表（GCS）评分<15或认知障碍；初始意识丧失；血流动力学不稳定；骨折体征；广泛皮下血肿；严重或难治性头痛；呕吐；癫痫发作；任何神经功能缺损；中毒；失忆；或神经外科手术史。第二组称为“非风险组”，由不具备上述任何标准的患者组成。
共纳入1415例患者。创伤后颅内出血（<0.001）、脑疝（=0.003）和骨折（<0.001）在风险组中发生的统计学频率更高。在非风险组中发现6例创伤后出血性脑损伤，这些损伤均未出现任何所研究的标准，且所有这些损伤均为轻微损伤（局限性蛛网膜下腔出血；毫米级硬膜下血肿）。此外，这些损伤均无需立即或延迟手术干预，且这些患者均未发生神经功能恶化或死亡。
总之，对于75岁及以上患有mTBI的老年患者，仅基于抗血栓治疗进行系统性头部CT扫描可能并无必要。
