Impact of age and anticoagulation: Need for neurosurgical intervention in trauma patients with mild traumatic brain injury
The Journal of Trauma and Acute Care Surgery,

Moore MM et al. – All patients aged 65years or older who present with a Glasgow Coma Scale (GCS) score of >13 after head trauma should undergo a screening computed tomography of the head regardless of prehospital use of anticoagulation. Patients younger than 65 years can be selectively screened based on presenting complaints and mechanism of injury provided they are not on anticoagulation.

Methods
  • A retrospective review of all adult (>14years) patients admitted to the Level I trauma service with a Glasgow Coma Scale (GCS) score of 14 to 15 who underwent neurosurgical intervention during their hospital stay was performed.
  • Patients were stratified into two groups, age <65years and age >=65years.
  • Each group was then further stratified by the use of anticoagulants: warfarin, aspirin, clopidogrel, or a combination.
  • Mechanism of injury, prehospital complaints, admission GCS, type of neurosurgical intervention, intensive care unit length of stay, hospital length of stay, and discharge disposition were evaluated.
  • Z test and logistic regression were used to compare proportions or percentages from different groups.

Results
  • Of the 7,678 patients evaluated during the study period, 101 (1.3%) required neurosurgical intervention.
  • The >=65years population underwent significantly more interventions as did those patients on anticoagulants.

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