Nuance and profound impact: Evaluating the effects of the unmet full coma scale in patients with mild subdural hemorrhage

Chien, Shuo-Chi; Kang, Shih-Ching; Tu, Po-Hsun; Chen, Ching-Chang; Tee, Yu-San; Liao, Chien-Hung; Chuang, Chi-Cheng; Fu, Chih-Yuan

doi:10.1016/j.ajem.2023.11.038

Cited by 1 publication

(1 citation statement)

References 25 publications

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“…These were con rmed by diagnostic test results (including doppler ultrasound, brain CT scan, or additional neurological imagining) during hospitalization. Neurologic deterioration was de ned according to any of the following criteria: (1) deterioration of Glasgow Coma Scale (GCS) score, (2) diminished muscle strength in the extremities, (3) occurrence of seizure attacks, (4) persistence or prolongation of symptoms such as headache, dizziness, or vomiting, and (5) signs of increased intracranial pressure, including hypertension, bradycardia, and irregular breathing patterns 16,17 . Rebleeding was de ned as neurologic deterioration in conjunction with increased hemorrhage burden on a repeated brain CT. Hyponatremia was de ned as serum sodium < 135 mEq/L within 48 hours of admission after the operation.…”

Section: Patient Selection and Data Collectionmentioning

confidence: 99%

Impact of Desmopressin on Clinical Outcomes in Patients with Spontaneous Antiplatelet-Associated Intracerebral Hemorrhage Undergoing Neurosurgical Intervention: An Observational Multi-Center Study

Hsu,

Shuo-Chi,

Chen

et al. 2024

Preprint

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Objective: Managing surgical cases of acute spontaneous intracerebral hemorrhage (ICH) in patients with antiplatelet therapy presents significant challenges due to the heightened risk of bleeding. Desmopressin acetate (DDAVP) is commonly employed as a management strategy. This multi-center study aims to compare the functional and safety outcomes in patients with or without preoperative DDAVP administration after spontaneous antiplatelet-associated ICH. Methods: From January 2016 to November 2023, we enrolled patients with spontaneous ICH who were under antiplatelet therapy and needed neurosurgical interventions in the emergency departments. Patients were excluded for traumatic brain injury, ICH from subarachnoid hemorrhage, arteriovenous malformation, intracranial tumors, coagulopathies, and anticoagulant use. The primary outcome was the modified Rankin Scale (mRS) at discharge. Secondary endpoints included safety outcomes, in-hospital and follow-up outcomes. Results: A total of 75 patients were included, comprising 26 patients treated with DDAVP and 49 patients in the control group. After inverse probability of treatment weighting adjustment, there were no significant differences in baseline characteristics except for preoperative platelet transfusion between the DDAVP and control group (73.6% vs 33.6%; p = 0.007). There were no significant differences in mRS of 4 – 6 at discharge between groups (77.4% vs 85.1%; p = 0.533). Multivariable generalized estimating equations logistic regression demonstrated DDAVP was not significantly associated with improved functional outcome, safety outcomes, in-hospital or follow-up outcomes. Conclusion: This study demonstrated that there was no significant difference in mRS at discharge or SAEs between patients with and without DDAVP administration. Further randomized controlled trials are warranted to validate our findings.

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Section: Patient Selection and Data Collectionmentioning

confidence: 99%