M. Lew1, W. Snyder1, B. Daley1 1University Of Tennessee Medical Center – Knoxville,Surgery,Knoxville, TN, USA
Introduction:
Repeat Computed Tomography of the Head (RCTH) is used to evaluate progression of traumatic brain injury (TBI) in patients on anticoagulants, even without neurologic change. We hypothesized patients with aspirin (ASA) therapy alone do not benefit from routine RCTH.
Methods:
Adult patients who were not anticoagulated (NAC) or on ASA alone with a TBI at a Level I trauma center were studied. Patients who underwent emergent neurosurgical intervention were excluded. Initial and RCTH, demographics, and Glasgow Coma Score (GCS) were reviewed. Primary outcome was delayed neurosurgical intervention. Secondary outcomes were progression of TBI, hospital length of stay, ventilator days, discharge GCS, and disposition.
Results:
From July 2012 to June 2015, 324 NAC and 110 ASA patients were identified. Mean age was 54, 61% were male, 39% were falls, and 55% were vehicular crashes. Initial GCS (14 ASA and 12 NAC) and subsequent GCS (14 ASA and 13 NAC) were better in ASA patients. While Injury Severity Scale was different (21 ASA and 25 NAC; p = 0.02), Head Abbreviated Injury Scale was not (3.8 both ASA and NAC). Progression was similar in ASA (22%) and NAC (29%) (not signficiant). No ASA and only 6 NAC patients (1.8%) had a neurosurgical intervention after RCTH (not significant). 4 of 54 patients (7%) with a decline in GCS and 5 of 46 patients (11%) with a subsequent GCS < or = 8 had neurosurgical intervention. Mortality was similar for ASA (7%) and NAC (6%). Hospital length of stay (2.4 to 3.8; p < 0.01) and ventilator days (0.7 to 1.9; p < 0.01) were decreased in the ASA group. Both groups had a discharge GCS of 15, but ASA discharge to home was less frequent (p = 0.004).
Conclusion:
RCTH is not warranted for patients with traumatic brain injuries in patients treated with aspirin. RCTH should be performed and is useful for those with a decline in neurologic status or GCS < or = 8.