Early diagnosis of delayed posttraumatic intracerebral hematomas

Díaz, Fernando G.; Yock, Douglas H.; Larson, David A.; Rockswold, Gaylan L.

doi:10.3171/jns.1979.50.2.0217

Cited by 98 publications

(24 citation statements)

References 16 publications

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“…Terms include delayed traumatic intracranial haemorrhage (DTICH) [7], expanding hematoma [19] and progressive hemorrhagic injury [10]. In this paper we combined these concepts such that we included both new haemorrhage and expanding haemorrhage (progressive intracranial haemorrhage).…”

Section: Discussionmentioning

confidence: 99%

Tranexamic acid for patients with traumatic brain injury: a randomized, double-blinded, placebo-controlled trial

et al. 2013

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BackgroundTraumatic brain injury (TBI) is commonly accompanied by intracranial bleeding which can worsen after hospital admission. Tranexamic acid (TXA) has been shown to reduce bleeding in elective surgery and there is evidence that short courses of TXA can reduce rebleeding in spontaneous intracranial haemorrhage. We aimed to determine the effectiveness and safety of TXA in preventing progressive intracranial haemorrhage in TBI.MethodsThis is a double blinded, placebo controlled randomized trial. We enrolled 238 patients older than 16 years with moderate to severe TBI (post-resuscitation Glasgow Coma Scale (GCS) 4 to 12) who had a computerized tomography (CT) brain scan within eight hours of injury and in whom there was no immediate indication for surgery. We excluded patients if they had a coagulopathy or a serum creatinine over than 2.0 milligrams%. The treatment was a single dose of 2 grams of TXA in addition to other standard treatments. The primary outcome was progressive intracranial haemorrhage (PIH) which was defined as an intracranial haemorrhage seen on the second CT scan that was not seen on the first CT scan, or an intracranial haemorrhage seen on the first scan that had expanded by 25% or more on any dimension (height, length, or width) on the second scan.ResultsProgressive intracranial haemorrhage was present in 21 (18%) of 120 patients allocated to TXA and in 32 (27%) of 118 patients allocated to placebo. The difference was not statistically significant [RR = 0.65 (95% CI 0.40 to 1.05)]. There were no significant difference in the risk of death from all causes in patients allocated to TXA compared with placebo [RR = 0.69 (95% CI 0.35 to 1.39)] and the risk of unfavourable outcome on the Glasgow Outcome Scale [RR = 0.76 (95% CI 0.46 to 1.27)]. There was no evidence of increased risk of thromboembolic events in those patients allocated to TXA.ConclusionsTXA may reduce PIH in patients with TBI; however, the difference was not statistically significant in this trial. Large clinical trials are needed to confirm and to assess the effect of TXA on death or disability after TBI.

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Section: Discussionmentioning

confidence: 99%

Tranexamic acid for patients with traumatic brain injury: a randomized, double-blinded, placebo-controlled trial

et al. 2013

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“…The 14-day follow up was deemed sufficient to identify clinically important delayed tICH. 8,18,19 Repeat cranial imaging was obtained at the discretion of the patients’ treating physicians. If patients were unable to be contacted by telephone survey or the EMR, the Social Security Death Index was reviewed to evaluate for death.…”

Section: Methodsmentioning

confidence: 99%

Immediate and Delayed Traumatic Intracranial Hemorrhage in Patients With Head Trauma and Preinjury Warfarin or Clopidogrel Use

Nishijima

Offerman

Ballard

et al. 2012

Annals of Emergency Medicine

149

126

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Study Objective Patients on warfarin or clopidogrel are considered at increased risk for traumatic intracranial hemorrhage (tICH) following blunt head trauma. The prevalence of immediate tICH and the cumulative incidence of delayed tICH in these patients, however, are unknown. Methods A prospective, observational study at two trauma centers and four community hospitals enrolled emergency department (ED) patients with blunt head trauma and pre-injury warfarin or clopidogrel use from April 2009 through January 2011. Patients were followed for two weeks. The prevalence of immediate tICH and the cumulative incidence of delayed tICH were calculated from patients who received an initial cranial computed tomography (CT) in the ED. Delayed tICH was defined as tICH within two weeks following an initially normal CT scan and in the absence of repeat head trauma. Results A total of 1,064 patients were enrolled (768 warfarin patients [72.2%] and 296 clopidogrel patients [27.8%]). There were 364 patients [34.2%] from Level 1 or 2 trauma centers and 700 patients [65.8%] from community hospitals. One thousand patients received a cranial CT scan in the ED. Both warfarin and clopidogrel groups had similar demographic and clinical characteristics although concomitant aspirin use was more prevalent among patients on clopidogrel. The prevalence of immediate tICH was higher in patients on clopidogrel (33/276, 12.0%; 95% confidence interval [CI] 8.4-16.4%) than patients on warfarin (37/724, 5.1%; 95%CI 3.6-7.0%), relative risk 2.31 (95%CI 1.48-3.63). Delayed tICH was identified in 4/687 (0.6%; 95%CI 0.2-1.5%) patients on warfarin and 0/243 (0%; 95%CI 0-1.5%) patients on clopidogrel. Conclusion While there may be unmeasured confounders that limit intergroup comparison, patients on clopidogrel have a significantly higher prevalence of immediate tICH compared to patients on warfarin. Delayed tICH is rare and occurred only in patients on warfarin. Discharging patients on anticoagulant or antiplatelet medications from the ED after a normal cranial CT scan is reasonable but appropriate instructions are required as delayed tICH may occur.

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“…Intracrebral hematomas (ICH) may occur following head trauma (Diaz et al 1979, Soloniuk et al 1986), or spontaneously, due to as variety of mechanisms (Ojemann and Heros 1983, Ott et al 1974, Paillas and Alliez 1973, Ropper and Davis 1980. The clinical presentation ofICH usually includes the sudden onset of headache, focal neurological deficits and depression of the level of consciousness , Ojemann and Heros 1983, Ott et al 1974, Paillas and Alliez 1973, Ropper and Davis 1980.…”

Section: Introductionmentioning

confidence: 99%

“…The clinical presentation ofICH usually includes the sudden onset of headache, focal neurological deficits and depression of the level of consciousness , Ojemann and Heros 1983, Ott et al 1974, Paillas and Alliez 1973, Ropper and Davis 1980. A small number of patients with either post-traumatic or spontaneous (Diaz et al 1979, Ojemann and Heros 1983, Ott et al 1974, Soloniuk et al 1986). ICH may develop signs of brainstem compression, which markedly worsens the prognosis for recovery , Ojemann and Heros 1983, Ott et al 1974, Soloniuk et al 1986).…”

Section: Introductionmentioning

confidence: 99%

Intracranial Pressure VII

Hoff¹,

Betz²

1989

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Early diagnosis of delayed posttraumatic intracerebral hematomas

Cited by 98 publications

References 16 publications

Tranexamic acid for patients with traumatic brain injury: a randomized, double-blinded, placebo-controlled trial

Tranexamic acid for patients with traumatic brain injury: a randomized, double-blinded, placebo-controlled trial

Immediate and Delayed Traumatic Intracranial Hemorrhage in Patients With Head Trauma and Preinjury Warfarin or Clopidogrel Use

Intracranial Pressure VII

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