HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan

Authors

  • Pedro Duarte-Batista Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. https://orcid.org/0000-0002-4436-4485
  • Nuno Cubas Farinha Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. https://orcid.org/0000-0002-2499-6610
  • Renata Marques Serviço de Neurocirurgia. Hospital De Braga. Braga.
  • João Páscoa Pinheiro Serviço de Neurocirurgia. Centro Hospitalar e Universitário de Coimbra. Coimbra.
  • João Silva Serviço de Neurocirurgia. Centro Hospitalar do Porto. Porto.
  • Rui Tuna Serviço de Neurocirurgia. Centro Hospitalar de São João. Porto.
  • José Hipólito Reis Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa.
  • Cristiano Antunes Serviço de Neurocirurgia. Hospital De Braga. Braga.
  • Maria João Machado Serviço de Neurocirurgia. Hospital De Braga. Braga.
  • Samuel Sequeira Lemos Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa.
  • Jessica Branco Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa.
  • Diogo Roque Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa.
  • Diogo Simão Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa.
  • Nuno Simas Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa.
  • Wilson Teixeira Serviço de Neurocirurgia. Centro Hospitalar Universitário de Lisboa Norte. Lisboa.
  • Cátia Felício Serviço de Cirurgia Geral. Centro Hospitalar Universitário de Lisboa Norte. Lisboa.
  • Miguel Ferreira Serviço de Neurocirurgia. Centro Hospitalar do Porto. Porto.
  • Eduardo Cunha Serviço de Neurocirurgia. Centro Hospitalar do Porto. Porto.
  • Luís Rocha Serviço de Neurocirurgia. Centro Hospitalar do Porto. Porto.
  • Gonçalo Figueiredo Serviço de Neurocirurgia. Centro Hospitalar do Porto. Porto.
  • Carolina Noronha Serviço de Neurocirurgia. Centro Hospitalar do Porto. Porto.
  • Vasco Pinto Serviço de Neurocirurgia. Centro Hospitalar do Porto. Porto.
  • Filipe Silva Serviço de Neurocirurgia. Centro Hospitalar do Porto. Porto.
  • Ana Ferreira Serviço de Neurocirurgia. Centro Hospitalar de São João. Porto.
  • Osvaldo Sousa Serviço de Neurocirurgia. Centro Hospitalar de São João. Porto.

DOI:

https://doi.org/10.20344/amp.13770

Keywords:

Anticoagulants, Brain Injuries, Traumatic, Intracranial Hemorrhage, Multicenter Study, Neurosurgical Procedures, Tomography, Spiral Computed

Abstract

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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Published

2021-06-01

How to Cite

1.
Duarte-Batista P, Farinha NC, Marques R, Pinheiro JP, Silva J, Tuna R, Reis JH, Antunes C, Machado MJ, Lemos SS, Branco J, Roque D, Simão D, Simas N, Teixeira W, Felício C, Ferreira M, Cunha E, Rocha L, Figueiredo G, Noronha C, Pinto V, Silva F, Ferreira A, Sousa O. HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan. Acta Med Port [Internet]. 2021 Jun. 1 [cited 2022 Dec. 10];34(6):413-9. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13770

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Original