Document Detail


Predicting intracranial lesions by antiplatelet agents in subjects with mild head injury.
MedLine Citation:
PMID:  20643657     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The effect of pre-injury antiplatelet treatment in the risk of intracranial lesions in subjects after mild head injury (Glasgow Coma Scale (GCS) 14-15) is uncertain.
METHODS: The potential risk was determined, considering its increasing use in guidelines on cardiovascular disease prevention, and ageing of the trauma population in Europe.
PATIENTS: The interaction of antiplatelet therapy with the prediction variables of main decision aids was analysed in 14,288 consecutive adolescent and adult subjects with mild head injury.
MEASUREMENTS: Any intracranial lesion at CT scan was selected as an outcome measure in a multivariable logistic regression analysis.
RESULTS: Intracranial lesions were demonstrated in 880 cases (6.2%), with an unfavourable outcome at 6 months in 86 (0.6%). Antiplatelet drugs were recorded in 10% of the entire cohort (24.7% in the group over 65 years). They increased the risk of intracranial lesions in the univariate analysis (OR 2.6; 95% CI 2.2 to 3.1), interacting with age in the multivariate analysis (antiplatelet OR 2.7 (1.9 to 3.7); age ≥75 years 1.4 (1.0 to 1.9)). The inclusion of these two variables with those included in previous decision aids for CT scanning (GCS, neurodeficit, post-traumatic seizures, suspected skull fracture, vomiting, loss of consciousness, coagulopathy) predicted intracranial lesions with a sensitivity of 99.7% (95% CI 98.9 to 99.8) and a specificity of 54.0% (95% CI 53.1 to 54.8), with a CT ordering rate of 49.3% (undetermined events 0.2:1000).
INTERPRETATION: Antiplatelet drugs need to be considered in future prediction models on mild head injury, considering their increasing use and progressive ageing of the trauma population.
Authors:
Andrea Fabbri; Franco Servadei; Giulio Marchesini; Sherman C Stein; Alberto Vandelli
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Publication Detail:
Type:  Journal Article     Date:  2010-07-18
Journal Detail:
Title:  Journal of neurology, neurosurgery, and psychiatry     Volume:  81     ISSN:  1468-330X     ISO Abbreviation:  J. Neurol. Neurosurg. Psychiatr.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-25     Completed Date:  2010-12-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985191R     Medline TA:  J Neurol Neurosurg Psychiatry     Country:  England    
Other Details:
Languages:  eng     Pagination:  1275-9     Citation Subset:  IM    
Affiliation:
Dipartimento dell'Emergenza, Presidio Ospedaliero Morgagni-Pierantoni, Azienda USL Forlì, Via Forlanini 34, I-47100 Forlì, Italy. dr.andrea.fabbri@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Cardiovascular Diseases / drug therapy*,  epidemiology*
Child
Craniocerebral Trauma / epidemiology*,  radiography*
Databases, Factual
Glasgow Coma Scale / statistics & numerical data
Humans
Logistic Models
Middle Aged
Multivariate Analysis
Platelet Aggregation Inhibitors / adverse effects*
Predictive Value of Tests
Risk Factors
Sensitivity and Specificity
Tomography, X-Ray Computed
Young Adult
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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