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Campiglio L, Bianchi F, Cattalini C, Belvedere D, Rosci CE, Casellato CL, Secchi M, Saetti MC, Baratelli E, Innocenti A, Cova I, Gambini C, Romano L, Oggioni G, Pagani R, Gardinali M, Priori A. Mild brain injury and anticoagulants: Less is enough. Neurol Clin Pract 2017; 7:296-305. [PMID: 29185534 PMCID: PMC5648198 DOI: 10.1212/cpj.0000000000000375] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/07/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite the higher theoretical risk of traumatic intracranial hemorrhage (ICH) in anticoagulated patients with mild head injury, the value of sequential head CT scans to identify bleeding remains controversial. This study evaluated the utility of 2 sequential CT scans at a 48-hour interval (CT1 and CT2) in patients with mild head trauma (Glasgow Coma Scale 13-15) taking oral anticoagulants. METHODS We retrospectively evaluated the clinical records of all patients on chronic anticoagulation treatment admitted to the emergency department for mild head injury. RESULTS A total of 344 patients were included, and 337 (97.9%) had a negative CT1. CT2 was performed on 284 of the 337 patients with a negative CT1 and was positive in 4 patients (1.4%), but none of the patients developed concomitant neurologic worsening or required neurosurgery. CONCLUSIONS Systematic routine use of a second CT scan in mild head trauma in patients taking anticoagulants is expensive and clinically unnecessary.
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Affiliation(s)
- Laura Campiglio
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
| | - Francesca Bianchi
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
| | - Claudio Cattalini
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
| | - Daniela Belvedere
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
| | - Chiara Emilia Rosci
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
| | - Chiara Livia Casellato
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
| | - Manuela Secchi
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
| | - Maria Cristina Saetti
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
| | - Elena Baratelli
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
| | - Alessandro Innocenti
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
| | - Ilaria Cova
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
| | - Chiara Gambini
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
| | - Luca Romano
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
| | - Gaia Oggioni
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
| | - Rossella Pagani
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
| | - Marco Gardinali
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
| | - Alberto Priori
- III Neurological Clinic, Department of Health Sciences (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), Neurology Unit (LC, FB, CC, DB, CER, CLC, MS, MCS, EB, AI, IC, CG, LR, GO, RP, AP), and Emergency Unit (MG), San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan University; Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan; and Fondazione IRCCS Ca' Granda (AP), Milan, Italy
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