A. V. Hoang1, P. Patel1, M. Broadwin1, T. Stansbury3, J. Brown2, M. Cipolle1 1Lehigh Valley Health Network, Allentown, PA, USA 2University Of South Florida College Of Medicine, Tampa, FL, USA 3MedStar Health Washington Hospital Center, Washington, DC, USA
Introduction:
Mild traumatic brain injury (mTBI) is one of the most common injuries seen in the emergency department. Computed tomography head (CTH) is standard in diagnosing intracranial injury. Repeat CTH is frequently performed in patients presenting with a high Glasgow Coma Scale (GCS) 13-15. This study aims to evaluate which factors contribute to worsening repeat CTH in patients with mTBI defined as GCS of ≥ 13 with an initial positive CTH scan.
Methods:
A retrospective review of a prospective trauma database analyzing 1542 patients at a level 1 trauma center from October 2015 to September 2019 was performed. 1433 patients met inclusion criteria of having a positive initial CTH that underwent repeat CTH. Bivariate analyses were conducted to determine if specific factors were associated with a worsening repeat CTH.
Results:
A total of 1236 patients had an unchanged or improved CTH while 197 patients had worsening CTH. Factors that were significantly associated with worsening CTH scan included: being on warfarin (p=0.0223), intensive care unit (ICU) length of stay (LOS) (p<0.0001), and need for neurosurgical intervention (NSI) (p= 0.0007). Interestingly, factors that were not associated with worsening CTH included age, transfer from an outside hospital (p=0.0410), and patients who were admitted with other types of anticoagulation such as apixaban (p=0.6556) or clopidogrel (p=0.1489). Different types of head bleeds were reviewed including subdural hemorrhage (SDH) (p<0.0001), and epidural hemorrhage (EDH) (p=0.0095). The only types of bleeds not associated with worsening CTH were subarachnoid hemorrhage (SAH) (p=0.1582).
Conclusion:
Worsening CTH was more common among patients who were taking warfarin, had longer ICU LOS, needed NSI, and were not transferred from outside hospitals. Other types of anticoagulation except for warfarin were not statistically significantly different between those who had a worsening CTH compared to those whose CTH stayed the same/ improved. All types of head bleeds except SAH had a higher incidence of worsening repeat CTH.
