Predicting Intracranial Lesions by Antiplatelet Agents in Subjects with Mild Head Injury

Andrea Fabbri (1) , Franco Servadei (2) , Giulio Marchesini (3) , Sherman C Stein (4) , Alberto Vandelli (1)

1 Dipartimento dell'Emergenza, Presidio Ospedaliero Morgagni-Pierantoni, Azienda USL Forlì
2 Unità Operativa di Neurochirurgia, Azienda Ospedaliero-Universitaria di Parma
3 UNIBO - Alma Mater Studiorum Università di Bologna = University of Bologna
4 Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia

Background: The effect of pre-injury antiplatelet treatment in the risk of intracranial lesions in subjects after mild head injury (Glasgow Coma Scale 14-15) is uncertain. Methods: We aimed to determine the potential risk, considering its increasing use in guidelines on cardiovascular disease prevention and aging of the trauma population in Europe. Patients: We analyzed the interaction of antiplatelet therapy with the prediction variables of main decision aids in 14,288 consecutive adolescent and adult subjects with mild head injury. Measurements: Any intracranial lesion at CT scan was selected as outcome measure in a multivariable logistic regression analysis. Findings: Intracranial lesions were demonstrated in 880 cases (6.2%), with an unfavorable outcome at 6 months in 86 (0.6%). Antiplatelet drugs were recorded in 10% of the entire cohort (24.7% in the group over 65 years). They increased the risk of intracranial lesions at univaried analysis (odds ratio - OR, 2.6; 95% confidence interval - 95% CI 2.2¨C3.1), interacting with age at multivariate analysis (antiplatelet: OR, 2.7 (1.9¨C3.7); age ¡Ý 75 years, 1.4 (1.0¨C1.9)). The inclusion of these two variables to those included in previous decision aids for CT scanning (GCS, neurodeficit, post-traumatic seizures, suspected skull fracture, vomiting, loss of consciousness, coagulopathy) predicted intracranial lesions with a sensitivity of 99.7% (95% CI 98.9¨C99.8) and a specificity of 54.0% (95%CI 53.1¨C54.8), with a CT ordering-rate of 49.3% (undetermined events, 0.2:1000). Interpretation: Antiplatelet drugs need to be considered in future prediction models on mild head injury, considering their increasing use and progressive aging of the trauma population

Mots clés: HEAD INJURY

Andrea Fabbri, Franco Servadei, Giulio Marchesini, Sherman C Stein, Alberto Vandelli. Predicting Intracranial Lesions by Antiplatelet Agents in Subjects with Mild Head Injury. Journal of Neurology, Neurosurgery and Psychiatry, 2010, 81 (11), pp.1275. ⟨10.1136/jnnp.2009.197467⟩. ⟨hal-00557433⟩