Decision tree analysis to predict the risk of intracranial haemorrhage after mild traumatic brain injury in patients taking DOACs |
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| Institution: | 1. Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy;2. Department of Emergency Medicine, Policlinico Univeristario di Verona, Azienda Ospedaliera Universitaria integrata, Verona, Italy;3. Department of Emergency Medicine, Girolamo Fracastoro Hospital of San Bonifacio, Azienda Ospedaliera Scaligera, San Bonifacio, Verona, Italy;4. Department of Emergency Medicine, Hospital Civile Maggiore, Azienda Ospedaliera Universitaria integrata, Verona, Italy;5. Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy;6. Franz Tappeiner Hospital, Azienda Sanitaria dell''Alto Adige, Department of Emergency Medicine Franz Tappeiner Hospital, Azienda Sanitaria dell''Alto Adige, Italy;1. Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China;2. Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom;3. Hepato-pancreato-biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China;4. Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China;1. Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, Pasadena, CA 91101, USA;2. Department of Urology, Southern California Permanente Medical Group, 4867 Sunset Boulevard, Los Angeles, CA 90027, USA;3. Regional Reference Laboratories, Southern California Permanente Medical Group, 11668 Sherman Way, North Hollywood, CA 91605, USA;4. Department of Quality and Clinical Analysis, Southern California Permanente Medical Group, 393 East Walnut Street, Pasadena, CA 91188, USA;5. Currently with the Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, 313 North Figueroa Street, Los Angeles, California 90012, USA;1. Department of Emergency Medicine, Lakeland Regional Health, Lakeland, FL, USA;2. Department of Pediatric Emergency Medicine, Lakeland Regional Health, Lakeland, FL, USA;3. Department of Research and Sponsored Studies, Lakeland Regional Health, Lakeland, FL, USA;1. Kırıkkale University, Faculty of Medicine, Department of Emergency Medicine, Kırıkkale, Turkey;2. Yozgat Bozok University, Faculty of Medicine, Department of Emergency Medicine, Yozgat, Turkey;3. Kırıkkale University, Faculty of Medicine, Department of Medical Biochemistry, Kırıkkale/Turkey;4. Kırıkkale University, Faculty of Medicine, Department of Radiology, Kırıkkale, Turkey |
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| Abstract: | 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. |
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