HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.16/2735 |
Resumo: | Introduction: Our national protocol for traumatic brain injury dictates that hypocoagulated patients with mild trauma and initial tomography scan with no intracranial traumatic changes must be hospitalized for 24 hours and do a post-surveillance tomography scan. The main goal of this study was to evaluate the clinical relevance of these measures. Material and methods: A prospective observational study was undertaken in four hospitals. Adult hypocoagulated traumatic brain injury patients with a normal tomography scan were included. The main outcomes evaluated were rate of delayed intracranial hemorrhage, rate of admission in a neurosurgical department, rate of complications related with surveillance and rate of prolonged hospitalization due to complications. An analysis combining data from a previously published report was also done. Results: A total of 178 patients were included. Four patients (2.3%) had a delayed hemorrhage and three (1.7%) were hospitalized in a neurosurgery ward. No cases of symptomatic hemorrhage were identified. No surgery was needed, and all patients had their anticoagulation stopped. Complications during surveillance were reported in seven patients (3.9%), of which two required prolonged hospitalization. Discussion: The rate of complications related with surveillance was higher than the rate of delayed hemorrhages. The initial period of in-hospital surveillance did not convey any advantage since the management of patients was never dictated by neurological changes. Post-surveillance tomography played a role in deciding about anticoagulation suspension and prolongation of hospitalization. Conclusion: Delayed hemorrhage is a rare event and the need for surgery even rarer. The need for in-hospital surveillance should be reassessed. |
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HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography ScanHIPTCN: Estudo Prospetivo Observacional de Doentes Traumatizados Cranioencefálicos Hipocoagulados com Tomografia Computorizada Inicial NormalAnticoagulantsBrain Injuries, TraumaticIntracranial Hemorrhage, TraumaticMulticenter StudyNeurosurgical ProceduresTomography, Spiral ComputedIntroduction: Our national protocol for traumatic brain injury dictates that hypocoagulated patients with mild trauma and initial tomography scan with no intracranial traumatic changes must be hospitalized for 24 hours and do a post-surveillance tomography scan. The main goal of this study was to evaluate the clinical relevance of these measures. Material and methods: A prospective observational study was undertaken in four hospitals. Adult hypocoagulated traumatic brain injury patients with a normal tomography scan were included. The main outcomes evaluated were rate of delayed intracranial hemorrhage, rate of admission in a neurosurgical department, rate of complications related with surveillance and rate of prolonged hospitalization due to complications. An analysis combining data from a previously published report was also done. Results: A total of 178 patients were included. Four patients (2.3%) had a delayed hemorrhage and three (1.7%) were hospitalized in a neurosurgery ward. No cases of symptomatic hemorrhage were identified. No surgery was needed, and all patients had their anticoagulation stopped. Complications during surveillance were reported in seven patients (3.9%), of which two required prolonged hospitalization. Discussion: The rate of complications related with surveillance was higher than the rate of delayed hemorrhages. The initial period of in-hospital surveillance did not convey any advantage since the management of patients was never dictated by neurological changes. Post-surveillance tomography played a role in deciding about anticoagulation suspension and prolongation of hospitalization. Conclusion: Delayed hemorrhage is a rare event and the need for surgery even rarer. The need for in-hospital surveillance should be reassessed.Introdução: O nosso protocolo nacional para traumatismos cranioencefálicos recomenda que doentes hipocoagulados com trauma craniano ligeiro e tomografia inicial sem alterações traumáticas intracranianas sejam hospitalizados 24 horas e façam uma tomografia computorizada pós-vigilância. O principal objetivo deste estudo foi avaliar a relevância clínica dessas medidas. Material e Métodos: Foi realizado em quatro hospitais um estudo prospetivo e observacional. Foram incluídos adultos hipocoagulados com trauma craniano e tomografia normal. Os principais outcomes avaliados foram: taxa de hemorragia intracraniana tardia, taxa de internamento numa enfermaria de neurocirurgia, taxa de complicações relacionadas com a vigilância e taxa de hospitalização prolongada por complicações. Resultados: Foram incluídos um total de 178 doentes. Quatro doentes (2,3%) apresentaram hemorragia tardia e três (1,7%) foram mantidos hospitalizados numa enfermaria de Neurocirurgia. Não foram documentados casos de hemorragia tardia sintomática. Nenhuma cirurgia foi necessária e em todos estes doentes a anticoagulação foi interrompida. Durante a vigilância, foram relatadas complicações em sete doentes (3,9%), dos quais dois exigiram hospitalização prolongada. Discussão: A taxa de complicações relacionadas com a vigilância foi maior do que a taxa de hemorragia tardia. O período inicial de vigilância intra-hospitalar não trouxe qualquer vantagem, já que o manejo dos doentes nunca foi ditado por alterações neurológicas. A tomografia pós-vigilância desempenhou um papel importante na decisão sobre a suspensão da anticoagulação e o prolongamento da hospitalização. Conclusão: A hemorragia tardia é um evento raro e a necessidade de cirurgia ainda mais. Deve ser reavaliada a necessidade de vigilância intra-hospitalar.Centro Editor Livreiro da Ordem dos MédicosRepositório Científico do Centro Hospitalar Universitário de Santo AntónioDuarte-Batista, PedroFarinha, Nuno CubasMarques, RenataPinheiro, João PáscoaSilva, JoãoTuna, RuiReis, José HipólitoAntunes, CristianoMachado, Maria JoãoLemos, Samuel SequeiraBranco, JessicaRoque, DiogoSimão, DiogoSimas, NunoTeixeira, WilsonFelício, CátiaFerreira, MiguelCunha, EduardoRocha, LuísFigueiredo, GonçaloNoronha, CarolinaPinto, VascoSilva, FilipeFerreira, AnaSousa, Osvaldo2022-08-29T09:51:03Z20212021-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.16/2735engDuarte-Batista P, Farinha NC, Marques R, et al. HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan. Acta Med Port. 2021;34(6):413-419. doi:10.20344/amp.137700870-399X10.20344/amp.13770info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-10-20T11:02:06Zoai:repositorio.chporto.pt:10400.16/2735Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:38:55.475315Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan HIPTCN: Estudo Prospetivo Observacional de Doentes Traumatizados Cranioencefálicos Hipocoagulados com Tomografia Computorizada Inicial Normal |
title |
HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan |
spellingShingle |
HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan Duarte-Batista, Pedro Anticoagulants Brain Injuries, Traumatic Intracranial Hemorrhage, Traumatic Multicenter Study Neurosurgical Procedures Tomography, Spiral Computed |
title_short |
HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan |
title_full |
HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan |
title_fullStr |
HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan |
title_full_unstemmed |
HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan |
title_sort |
HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan |
author |
Duarte-Batista, Pedro |
author_facet |
Duarte-Batista, Pedro Farinha, Nuno Cubas Marques, Renata Pinheiro, João Páscoa Silva, João Tuna, Rui Reis, José Hipólito Antunes, Cristiano Machado, Maria João Lemos, Samuel Sequeira Branco, Jessica Roque, Diogo Simão, Diogo Simas, Nuno Teixeira, Wilson Felício, Cátia Ferreira, Miguel Cunha, Eduardo Rocha, Luís Figueiredo, Gonçalo Noronha, Carolina Pinto, Vasco Silva, Filipe Ferreira, Ana Sousa, Osvaldo |
author_role |
author |
author2 |
Farinha, Nuno Cubas Marques, Renata Pinheiro, João Páscoa Silva, João Tuna, Rui Reis, José Hipólito Antunes, Cristiano Machado, Maria João Lemos, Samuel Sequeira Branco, Jessica Roque, Diogo Simão, Diogo Simas, Nuno Teixeira, Wilson Felício, Cátia Ferreira, Miguel Cunha, Eduardo Rocha, Luís Figueiredo, Gonçalo Noronha, Carolina Pinto, Vasco Silva, Filipe Ferreira, Ana Sousa, Osvaldo |
author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
Repositório Científico do Centro Hospitalar Universitário de Santo António |
dc.contributor.author.fl_str_mv |
Duarte-Batista, Pedro Farinha, Nuno Cubas Marques, Renata Pinheiro, João Páscoa Silva, João Tuna, Rui Reis, José Hipólito Antunes, Cristiano Machado, Maria João Lemos, Samuel Sequeira Branco, Jessica Roque, Diogo Simão, Diogo Simas, Nuno Teixeira, Wilson Felício, Cátia Ferreira, Miguel Cunha, Eduardo Rocha, Luís Figueiredo, Gonçalo Noronha, Carolina Pinto, Vasco Silva, Filipe Ferreira, Ana Sousa, Osvaldo |
dc.subject.por.fl_str_mv |
Anticoagulants Brain Injuries, Traumatic Intracranial Hemorrhage, Traumatic Multicenter Study Neurosurgical Procedures Tomography, Spiral Computed |
topic |
Anticoagulants Brain Injuries, Traumatic Intracranial Hemorrhage, Traumatic Multicenter Study Neurosurgical Procedures Tomography, Spiral Computed |
description |
Introduction: Our national protocol for traumatic brain injury dictates that hypocoagulated patients with mild trauma and initial tomography scan with no intracranial traumatic changes must be hospitalized for 24 hours and do a post-surveillance tomography scan. The main goal of this study was to evaluate the clinical relevance of these measures. Material and methods: A prospective observational study was undertaken in four hospitals. Adult hypocoagulated traumatic brain injury patients with a normal tomography scan were included. The main outcomes evaluated were rate of delayed intracranial hemorrhage, rate of admission in a neurosurgical department, rate of complications related with surveillance and rate of prolonged hospitalization due to complications. An analysis combining data from a previously published report was also done. Results: A total of 178 patients were included. Four patients (2.3%) had a delayed hemorrhage and three (1.7%) were hospitalized in a neurosurgery ward. No cases of symptomatic hemorrhage were identified. No surgery was needed, and all patients had their anticoagulation stopped. Complications during surveillance were reported in seven patients (3.9%), of which two required prolonged hospitalization. Discussion: The rate of complications related with surveillance was higher than the rate of delayed hemorrhages. The initial period of in-hospital surveillance did not convey any advantage since the management of patients was never dictated by neurological changes. Post-surveillance tomography played a role in deciding about anticoagulation suspension and prolongation of hospitalization. Conclusion: Delayed hemorrhage is a rare event and the need for surgery even rarer. The need for in-hospital surveillance should be reassessed. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021 2021-01-01T00:00:00Z 2022-08-29T09:51:03Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.16/2735 |
url |
http://hdl.handle.net/10400.16/2735 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Duarte-Batista P, Farinha NC, Marques R, et al. HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan. Acta Med Port. 2021;34(6):413-419. doi:10.20344/amp.13770 0870-399X 10.20344/amp.13770 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Centro Editor Livreiro da Ordem dos Médicos |
publisher.none.fl_str_mv |
Centro Editor Livreiro da Ordem dos Médicos |
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reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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