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Lookup NU author(s): Professor Dawn Teare
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Objectives Management of anticoagulated patients after head injury is unclear due to lack of robust evidence. This study aimed to determine the adverse outcome rate in these patients and identify risk factors associated with poor outcome. Design Multicentre, observational study using routine patient records. Setting 33 emergency departments in England and Scotland. Participants 3566 adults (aged ≥16â €..years) who had suffered blunt head injury and were currently taking warfarin. Main outcome measures Primary outcome measure was rate of adverse outcome defined as death or neurosurgery following initial injury, clinically significant CT scan finding or reattendance with related complication within 10â €..weeks of initial hospital attendance. Secondary objectives included identifying risk factors for adverse outcome using univariable and multivariable analyses. Results Clinical data available for 3534/3566 patients (99.1%), median age 79â €..years; mean initial international normalised ratio (INR) 2.67 (SD 1.34); 81.2% Glasgow Coma Scale (GCS) 15: 59.8% received a CT scan with significant head injury-related finding in 5.4% (n=208); 0.5% underwent neurosurgery; 1.2% patients suffered a head injury-related death. Overall adverse outcome rate was 5.9% (95% CI 5.2% to 6.7%). Patients with GCS=15 and no associated symptoms had lowest risk of adverse outcome (risk 2.7%; 95% CI 2.1 to 3.6). Patients with GCS=15 multivariable analysis (using imputation) found risk of adverse outcome to increase when reporting at least one associated symptom: vomiting (relative risk (RR) 1.8; 95% CI 1.0 to 3.4), amnesia (RR 3.5; 95% CI 2.1 to 5.7), headache (RR 1.3; 95% CI 0.8 to 2.2), loss of consciousness (RR 1.75; 95% CI 1.0 to 3.0). INR measurement did not predict adverse outcome in patients with GCS=15 (RR 1.1; 95% CI 1.0 to 1.2). Conclusions In alert warfarinised patients following head injury, the presence of symptoms is associated with greater risk of adverse outcome. Those with GCS=15 and no symptoms are a substantial group and have a low risk of adverse outcome. Trial registration number NCT02461498.
Author(s): Mason S, Kuczawski M, Teare MD, Stevenson M, Goodacre S, Ramlakhan S, Morris F, Rothwell J
Publication type: Article
Publication status: Published
Journal: BMJ Open
Online publication date: 13/01/2017
Acceptance date: 15/12/2016
Date deposited: 12/11/2019
ISSN (electronic): 2044-6055
Publisher: BMJ Publishing Group
PubMed id: 28087556
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