• Am J Emerg Med · Dec 2021

    Multicenter Study Observational Study

    Decision tree analysis to predict the risk of intracranial haemorrhage after mild traumatic brain injury in patients taking DOACs.

    • Gianni Turcato, Arian Zaboli, Norbert Pfeifer, Antonio Maccagnani, Andrea Tenci, Alberto Giudiceandrea, Massimo Zannoni, Giorgio Ricci, Antonio Bonora, and Francesco Brigo.
    • Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Franz Tappeiner Hospital, Azienda Sanitaria dell'Alto Adige, Department of Emergency Medicine Franz Tappeiner Hospital, Azienda Sanitaria dell'Alto Adige, Italy. Electronic address: gianni.turcato@yahoo.it.
    • Am J Emerg Med. 2021 Dec 1; 50: 388-393.

    BackgroundAlthough the preliminary evidence seems to confirm a lower incidence of post-traumatic bleeding in patients treated with direct oral anticoagulants (DOACs) compared to those on vitamin K antagonists (VKAs), the recommended management of mild traumatic brain injury (MTBI) in patients on DOACs is the same as those on the older VKAs, risking excessive use of CT in the emergency department (ED).AimTo determine which easily identifiable clinical risk factors at the first medical evaluation in the ED may indicate an increased risk of post-traumatic intracranial haemorrhage (ICH) in patients on DOACs with MTBI.MethodsPatients on DOACs who were evaluated in the ED for an MTBI from 2016 to 2020 at four centres in Northern Italy were considered. A decision tree analysis using the chi-square automatic interaction detection (CHAID) method was conducted to assess the risk of post-traumatic ICH after an MTBI. Known pre- and post-traumatic clinical risk factors that are easily identifiable at the first medical evaluation in the ED were used as input predictor variables.ResultsAmong the 1146 patients on DOACs in this study, post-traumatic ICH was present in 6.5% (75/1146). Decision tree analysis using the CHAID method found post-traumatic TLOC, post-traumatic amnesia, major trauma dynamic, previous neurosurgery and evidence of trauma above the clavicles to be the strongest predictors associated with the presence of post-traumatic ICH in patients on DOACs. The absence of a concussion seems to indicate subgroups at very low risk of requiring neurosurgery.ConclusionsThe machine-based CHAID model identified distinct prognostic groups of patients with distinct outcomes based on clinical factors. Decision trees can be useful as guides for patient selection and risk stratification.Copyright © 2021 Elsevier Inc. All rights reserved.

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