Predicting intracranial lesions by antiplatelet agents in subjects with mild head injury
- 1Dipartimento dell'Emergenza, Presidio Ospedaliero Morgagni-Pierantoni, Azienda Unità Sanitaria Locale di Forlì, Italy
- 2Unità Operativa di Neurochirurgia, Azienda Ospedaliero-Universitaria di Parma, Italy
- 3Alma Mater Studiorum, Università di Bologna, Italy
- 4Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Correspondence to Dr A Fabbri, Dipartimento dell'Emergenza, Presidio Ospedaliero Morgagni-Pierantoni, Azienda USL Forlì, Via Forlanini 34, I-47100 Forlì, Italy;
Contributors AF conceived the study, wrote the protocol, coordinated the data collection, interpretation of results and wrote the paper. FS contributed to the interpretation of the results and critical review of the paper. GM, contributed to the study design, interpretation of the results and co-wrote the paper. SS, contributed to the interpretation of the results and critical review of the paper and co-wrote the paper. AV contributed to study design, study coordination, interpretation of the results and critical review of the paper. All authors approved the final version of the paper.
- Received 14 October 2009
- Revised 14 January 2010
- Accepted 11 February 2010
- Published Online First 18 July 2010
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.
Competing interests None.
Ethics approval This study was conducted with the approval of the local ethics committee of Azienda USL, Forlì, Italy.
Provenance and peer review Not commissioned; externally peer reviewed.