Mild brain injury and anticoagulants

Campiglio, Laura; Bianchi, Francesca; Cattalini, Claudio; Belvedere, D.; Rosci, Chiara; Casellato, C.; Secchi, Manuela; Saetti, Maria Cristina; Baratelli, E; Innocenti, Alessandro; Cova, Ilaria; Gambini, Chiara; Romanò, Luca; Oggioni, Gaia Donata; Pagani, R.; Gardinali, M; Priori, Alberto

doi:10.1212/cpj.0000000000000375

Cited by 25 publications

(21 citation statements)

References 39 publications

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“…Several of these examinations already have established referral criteria or have recommendations against them in the Choosing Wisely list, however this review show that these are still being used in clinical practice, and more examinations might need referral guidelines. The most commonly practices reported as low-value was head CT in several clinical queries (especially related to minor head injury [ 20 – 33 , 36 , 37 , 40 – 53 , 55 , 56 , 286 – 293 ]), chest X-ray for routine checkup or follow-ups [ 78 – 113 , 118 – 120 , 339 – 343 ], trauma CT in patients without clinical symptoms or as repeat scans [ 227 – 232 , 287 , 314 – 322 ], and skeletal X-rays in non-traumatic pain or in fracture follow-ups [ 132 , 138 , 139 , 151 – 156 , 160 – 167 , 169 , 323 – 337 ]. The following were the most frequently reported low-value examinations: imaging in low back pain [ 121 – 131 ] and knee MRI without red flags [ 121 , 141 – 147 ], staging and follow-up in several types of cancer (X-ray, CT, MRI and nuclear medicine) [ 58 , 116 , 172 , 199 – 203 , 209 , 234 – 262 ], abdominal CT in self-limiting episode of suspected urolithiasis [ 190 , 204 – 206 ], chest CTA [ 210 – 216 ] and ultrasound lower limb veins in patients with low risk of thrombosis [ 217 – 221 ] were most prominent among adult populations.…”

Section: Discussionmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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Background Inappropriate and wasteful use of health care resources is a common problem, constituting 10–34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging—in which the diagnostic test confers little to no clinical benefit—is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. Methods A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. Results A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. Conclusions A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. Systematic review registration: PROSPERO: CRD42020208072.

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Section: Discussionmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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“…It can also have negative health impacts for patients such as delirium and missed medications or meals. This change in practice has occurred despite available research evidence suggesting that the risk of significant bleeding and death is very low …”

Section: Introductionmentioning

confidence: 99%

Does the evidence justify routine transfer of residents of aged care facilities for CT scan after minor head trauma?

Green

Selleck

Gibbons

et al. 2020

Internal Medicine Journal

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Background In 2014, the South Australian coroner recommended that residents of residential aged care facilities (RACF) who had sustained a head injury should be transported to emergency departments (ED) for assessment and a head CT scan, with the view to preventing mortality. The evidence base for the recommendation is unclear. Aims To determine the rate of emergent intervention (neurosurgery, transfusion of blood products or reversal of anti‐coagulation) in residents transferred to ED with minor head trauma who had their usual cognitive function on ED assessment. Methods This was a retrospective cohort study by medical records review at two university‐affiliated community ED. Participants were patients from RACF attending ED who had suffered minor head trauma and had their usual cognitive function. Exclusions were altered conscious state, new neurological findings or associated orthopaedic injury requiring hospital admission. The primary outcome was rate of emergent intervention in residents transferred to ED with minor head trauma who had their usual cognitive function on ED assessment. Results A total of 366 patients was studied; median age 86 years, 45% taking anti‐coagulant/anti‐platelet medication. Eighty per cent underwent head CT. Six per cent had intracranial haemorrhage (ICH; 95% CI 4–8.9%). No patient underwent neurosurgery. One had emergent intervention, reversal of anti‐coagulation (0.3%, 95% CI 0.05–1.5%). Conclusion The rate of emergent intervention for ICH in patients from RACF who sustained a minor head trauma but had their normal cognitive function was <1%. None underwent neurosurgical intervention. The low rate of intervention seriously challenges the appropriateness of routine transfer and CT for this patient group.

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“…Several authors suggested that most of observed patients can be safely discharged without a second CT scan, in the absence of clinical impairment, due to the low rates of delayed ICH occurring after 24 h from trauma. [ 38 39 40 41 42 43 ]…”

Section: Discussionmentioning

confidence: 99%

Management of mild brain trauma in the elderly: Literature review

et al. 2020

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Purpose: The world population is aging. As direct consequence, geriatric trauma is increasing both in absolute number and in the proportion of annual admissions causing a challenge for the health-care system worldwide. The aim of this review is to delineate the specific and practice rules for the management of mild brain trauma in the elderly. Methods: Systematic review of the last 15 years literature on mild traumatic brain injury (nTBI) in elderly patients. Results: A total of 68 articles m et al l eligibility criteria and were selected for the systematic review. We collected 29% high-quality studies and 71% low-quality studies. Conclusion: Clinical advices for a comprehensive management are provided. Current outcome data from mTBIs in the elderly show a condition that cannot be sustained in the future by families, society, and health-care systems. There is a strong need for more research on geriatric mild brain trauma addressed to prevent falls, to reduce the impact of polypharmacy, and to define specific management strategies.

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Mild brain injury and anticoagulants

Abstract: Systematic routine use of a second CT scan in mild head trauma in patients taking anticoagulants is expensive and clinically unnecessary.

Cited by 25 publications

References 39 publications

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Does the evidence justify routine transfer of residents of aged care facilities for CT scan after minor head trauma?

Management of mild brain trauma in the elderly: Literature review

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