Abstract：
BACKGROUND: Mild traumatic brain injuries (mTBIs) pose a significant risk, particularly in the elderly population on anticoagulation therapy. The safety of discharging these patients from the emergency department (ED) with a negative initial computed tomography (CT) scan has been debated due to the risk of delayed intracranial hemorrhage (d-ICH).
OBJECTIVE: To compare outcomes, including d-ICH, between elderly patients on anticoagulation therapy presenting with mTBI who were admitted versus discharged from the ED after an initial negative head CT scan.
METHODS: We conducted a retrospective observational study at the Chaim Sheba Medical Center, assessing outcomes of 1598 elderly patients on anticoagulation therapy who presented with mTBI and an initial negative head CT scan. Patients were either admitted for 24-h observation (Group A, n = 829) or discharged immediately from the ED (Group B, n = 769). The primary outcome was incidence of d-ICH within 14 days.
RESULTS: Among the 1598 patients included in the study, 46 admitted patients and 1 discharged patient returned within 14 days for repeat CT, identifying one asymptomatic hemorrhage in the discharged patient. Mortality at 30 days was significantly higher in admitted patients compared to discharged patients (4.8% vs. 1.8%, p = 0.001), though cause of death was unrelated to head injury in both groups.
CONCLUSIONS: In elderly patients on anticoagulation with mTBI and a negative initial CT, admission was associated with a higher risk of d-ICH compared to discharge. These findings have implications for clinical decision-making in this high-risk population.
OBJECTIVE: To compare outcomes, including d-ICH, between elderly patients on anticoagulation therapy presenting with mTBI who were admitted versus discharged from the ED after an initial negative head CT scan.
METHODS: We conducted a retrospective observational study at the Chaim Sheba Medical Center, assessing outcomes of 1598 elderly patients on anticoagulation therapy who presented with mTBI and an initial negative head CT scan. Patients were either admitted for 24-h observation (Group A, n = 829) or discharged immediately from the ED (Group B, n = 769). The primary outcome was incidence of d-ICH within 14 days.
RESULTS: Among the 1598 patients included in the study, 46 admitted patients and 1 discharged patient returned within 14 days for repeat CT, identifying one asymptomatic hemorrhage in the discharged patient. Mortality at 30 days was significantly higher in admitted patients compared to discharged patients (4.8% vs. 1.8%, p = 0.001), though cause of death was unrelated to head injury in both groups.
CONCLUSIONS: In elderly patients on anticoagulation with mTBI and a negative initial CT, admission was associated with a higher risk of d-ICH compared to discharge. These findings have implications for clinical decision-making in this high-risk population.
摘要：
背景：轻度创伤性脑损伤（mTBI）具有很大的风险，尤其是在接受抗凝治疗的老年人群中。由于存在迟发性颅内出血（d-ICH）的风险，因此对这些患者从急诊科（ED）出院的安全性进行了辩论。
目的：为了比较结果，包括d-ICH，接受抗凝治疗并出现mTBI的老年患者在初次头部CT扫描阴性后入院与出院之间的关系.
方法：我们在ChaimSheba医疗中心进行了一项回顾性观察研究，评估1598例接受抗凝治疗并出现mTBI和最初头部CT扫描阴性的老年患者的结局。患者要么入院24小时观察(A组，n=829)或立即从ED出院(B组，n=769）。主要结果是14天内d-ICH的发生率。
结果：在纳入研究的1598名患者中，46名入院患者和1名出院患者在14天内返回进行重复CT，确定出院患者的无症状出血。入院患者30天时的死亡率明显高于出院患者(4.8%vs.1.8%,p=0.001),尽管两组的死亡原因与头部损伤无关。
结论：在接受mTBI和初始CT阴性的抗凝治疗的老年患者中，与出院相比,入院与更高的d-ICH风险相关.这些发现对这一高风险人群的临床决策具有重要意义。
目的：为了比较结果，包括d-ICH，接受抗凝治疗并出现mTBI的老年患者在初次头部CT扫描阴性后入院与出院之间的关系.
方法：我们在ChaimSheba医疗中心进行了一项回顾性观察研究，评估1598例接受抗凝治疗并出现mTBI和最初头部CT扫描阴性的老年患者的结局。患者要么入院24小时观察(A组，n=829)或立即从ED出院(B组，n=769）。主要结果是14天内d-ICH的发生率。
结果：在纳入研究的1598名患者中，46名入院患者和1名出院患者在14天内返回进行重复CT，确定出院患者的无症状出血。入院患者30天时的死亡率明显高于出院患者(4.8%vs.1.8%,p=0.001),尽管两组的死亡原因与头部损伤无关。
结论：在接受mTBI和初始CT阴性的抗凝治疗的老年患者中，与出院相比,入院与更高的d-ICH风险相关.这些发现对这一高风险人群的临床决策具有重要意义。
