【摘 要】
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Objective: To assess the essential need of undergoing an urgent CT scan in patients with traumatic head injury.To establish which antiplatlets increase the risk of intracranial bleed To determine pred
【出 处】
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中华放射学学术大会2016、中华医学会第23次全国放射学学术大会暨中华医学会第24次全国影像技术学术大会
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Objective: To assess the essential need of undergoing an urgent CT scan in patients with traumatic head injury.To establish which antiplatlets increase the risk of intracranial bleed To determine predictive factors that increase the risk of having an intracranial haemorrhage.Method: Data(January2015-January 2016)from 368 patients were reviewed retrospectively using the CPD system and patients case notes.Age,medications,GCS,neurological signs/symptoms,mechanism of injury and CT scan findings were collected in this study.Result: 12.5%of our patients were found to have an intracranial bleed after undergoing an urgent CT scan(within 4 hours upon arriving to the emergency department).172 patients were found to be on anticoagulants(Warfarin,Antiplatlets and NOACs).Antiplatlets,in particular patients on Clopidogrel,were found to have the most profound risk factor of having an intracranial hematoma/hemorrhage with an estimated odds of 18(p<0.005).Warfarin was also seen to increase the risk with an estimated odds of 11(p<0.005),whilst NOACs/aspirin had no effect on the findings of the CT scan.Furthermore,the best neurological sign in predicting whether or not they had a bleed was the Glasscow Coma Score,especially those who had a score of less than 13.This was followed by loss of consciousness,amnesia,and vomited(more than twice),with an estimated odds of 20,16 and 7 respectively(p<0.005).Extra cranial bruising/hematomas did not influence the findings of CT results,and therefore those patients should not be scanned.Conclusion: Patients who are on anticoagulants,apart from NOACs,need to undergo an urgent CT scan within 4 hours of arriving to ED.Furthermore,patients who have neurological signs,including Amnesia,LOC,vomiting(more than twice),must also be scanned and referred to the neurosurgical team for further advise.Alcohol intoxication and road traffic accidents were the only mechanisms of head injury that were deemed to increase the risk of having an intracranial bleed.
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