• Farès Moustafa, Jean Roubin, Bruno Pereira, Alain Barres, Jennifer Saint-Denis, Christophe Perrier, Marine Mondet, Frederic Dutheil, and Jeannot Schmidt.
• Emergency Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France. fmoustafa@chu-clermontferrand.fr.
• Scand J Trauma Resus. 2018 Jun 19; 26 (1): 50.

BackgroundIn head trauma cases involving antiplatelet agent treatment, the French Society of Emergency Medicine recommends performing computed tomography (CT) scans to detect brain lesions, 90% of which are normal. The value of CT is still debatable given the scarce number of studies and controversial results.MethodsWe used the RATED registry (Registry of patient with Antithrombotic agents admitted to an Emergency Department, NCT02706080) to assess factors of cerebral bleeding related to antiplatelet agents following head trauma.ResultsFrom January 2014 to December 2015, 993 patients receiving antiplatelet agents were recruited, 293 (29.5%) of whom underwent CT scans for brain trauma. Intracranial bleeding was found in 26 (8.9%). Multivariate analysis revealed these patients more likely to have a history of severe hemorrhage (odds ratio [OR]: 8.47, 95% confidence interval [CI]: 1.56-45.82), dual antiplatelet therapy (OR: 6.46, 95%CI:1.46-28.44), headache or vomiting (OR: 4.27, 95%CI: 1.44-2.60), and abnormal Glasgow coma scale (OR: 8.60; 95%CI: 2.85-25.99) compared to those without intracranial bleeding. The predictive model derived from these variables achieved 98.9% specificity and a negative predictive value of 92%. The area under the ROC curve (AUROC) was 0.85 (95%CI: 0.77-0.93).ConclusionsOur study demonstrated that the absence of history of severe hemorrhage, dual antiplatelet therapy, headache or vomiting, and abnormal Glasgow coma scale score appears to predict normal CT scan following traumatic brain injury in patients taking antiplatelets. This finding requires confirmation by prospective studies.Trial RegistrationClinicalTrials.gov number: NCT02706080 .

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