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

2021Journal article Open access
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dc.contributor.authorDuarte-Batista, Pedro
dc.contributor.authorFarinha, Nuno Cubas
dc.contributor.authorMarques, Renata
dc.contributor.authorPinheiro, João Páscoa
dc.contributor.authorSilva, João
dc.contributor.authorTuna, Rui
dc.contributor.authorReis, José Hipólito
dc.contributor.authorAntunes, Cristiano
dc.contributor.authorMachado, Maria João
dc.contributor.authorLemos, Samuel Sequeira
dc.contributor.authorBranco, Jessica
dc.contributor.authorRoque, Diogo
dc.contributor.authorSimão, Diogo
dc.contributor.authorSimas, Nuno
dc.contributor.authorTeixeira, Wilson
dc.contributor.authorFelício, Cátia
dc.contributor.authorFerreira, Miguel
dc.contributor.authorCunha, Eduardo
dc.contributor.authorRocha, Luís
dc.contributor.authorFigueiredo, Gonçalo
dc.contributor.authorNoronha, Carolina
dc.contributor.authorPinto, Vasco
dc.contributor.authorSilva, Filipe
dc.contributor.authorFerreira, Ana
dc.contributor.authorSousa, Osvaldo
dc.date.accessioned2022-08-29T09:51:03Z
dc.date.available2022-08-29T09:51:03Z
dc.date.issued2021
dc.description.abstractIntroduction: 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.pt_PT
dc.description.abstractIntrodução: 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationDuarte-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.13770pt_PT
dc.identifier.doi10.20344/amp.13770pt_PT
dc.identifier.issn0870-399X
dc.identifier.issn1646-0758
dc.identifier.urihttp://hdl.handle.net/10400.16/2735
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherCentro Editor Livreiro da Ordem dos Médicospt_PT
dc.relation.publisherversionhttps://actamedicaportuguesa.com/revista/index.php/amp/article/view/13770pt_PT
dc.subjectAnticoagulantspt_PT
dc.subjectBrain Injuries, Traumaticpt_PT
dc.subjectIntracranial Hemorrhage, Traumaticpt_PT
dc.subjectMulticenter Studypt_PT
dc.subjectNeurosurgical Procedurespt_PT
dc.subjectTomography, Spiral Computedpt_PT
dc.titleHIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scanpt_PT
dc.title.alternativeHIPTCN: Estudo Prospetivo Observacional de Doentes Traumatizados Cranioencefálicos Hipocoagulados com Tomografia Computorizada Inicial Normalpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlacePortugalpt_PT
oaire.citation.endPage419pt_PT
oaire.citation.issue6pt_PT
oaire.citation.startPage413pt_PT
oaire.citation.titleActa Médica Portuguesapt_PT
oaire.citation.volume34pt_PT
person.familyNameNoronha Gil
person.givenNameCarolina
person.identifier.ciencia-idDE15-27D1-5BE2
person.identifier.orcid0000-0001-9520-5989
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublicationf93a1321-c089-4c38-aa8a-44de3760a34e
relation.isAuthorOfPublication.latestForDiscoveryf93a1321-c089-4c38-aa8a-44de3760a34e

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