Serotonergic Antidepressants and Risk for Traumatic Intracranial Bleeding

Background: Serotonergic antidepressants may predispose to bleeding but the effect on traumatic intracranial bleeding is unknown.Methods: The rate of intracranial bleeding in patients with antidepressant medication was compared to patients not antidepressants in a cohort of patients with acute head injury. This association was examined by using a consecutive cohort of head trauma patients from a Finnish tertiary center emergency department (Tampere University Hospital, Tampere, Finland). All consecutive (2010–2012) adult patients (n = 2,890; median age = 58; male = 56%, CT-positive = 22%, antithrombotic medication users = 25%, antidepressant users = 10%) who underwent head CT due to head trauma in the emergency department were included.Results: Male gender, GCS <15, older age, and anticoagulation were associated with an increased risk for traumatic intracranial bleeding. There were 17.8% of patients not taking antidepressants and 18.3% of patients on an antidepressant who had traumatic intracranial bleeding (p = 0.830). Among patients who were taking antithrombotic medication, 16.6% of the patients not taking antidepressant medication, and 22.5% of the patients taking antidepressant medication, had bleeding (p = 0.239). In a regression analysis, traumatic intracranial hemorrhage was not associated with antidepressant use.Conclusions: Serotonergic antidepressant use was not associated with an increased risk of traumatic intracranial hemorrhage.

The effects of antithrombotic therapy on head trauma and its management

The number of patients with traumatic intracranial hemorrhage (tICH) that are taking antithrombotics (ATs), antiplatelets (APs) and/or anticoagulants (ACs), has increased, but the influence of it for outcome remains unclear. This study aimed to evaluate an influence of AT for tICH. We retrospectively reviewed all patients with tICH treated between 2012 and 2019, and analyzed demographics, neurological status, clinical course, radiological findings, and outcome data. A total of 393 patients with tICH were included; 117 were on AT therapy (group A) and 276 were not (group B). Fifty-one (43.6%) and 159 (57.6%) patients in groups A and B, respectively, exhibited mRS of 0–2 at discharge (p = 0.0113). Mortality at 30 days was significantly higher in group A than in group B (25.6% vs 16.3%, p = 0.0356). Multivariate analysis revealed that higher age (OR 32.7, p < 0.0001), female gender (OR 0.56, p = 0.0285), pre-injury vitamin K antagonist (VKA; OR 0.42, p = 0.0297), and hematoma enlargement (OR 0.27, p < 0.0001) were associated with unfavorable outcome. AP and direct oral anticoagulant were not. Hematoma enlargement was significantly higher in AC-users than in non-users. Pre-injury VKA was at high risk of poor prognosis for patients with tICH. To improve outcomes, the management of VKA seems to be important.

A United States national analysis of basic demographics and commodities in sudden cardiac arrest

Background Cardiac arrest is a condition associated with high mortality rate and can cause significant social-economical burden in United States. Our study aim is to analyze the basic demographic of patients admitted for cardiac arrest and the incidence of complications following cardiac arrest. Methods Using the National Inpatient Sample from 2016–2018, we identified all the hospital admissions with a primary diagnosis code at discharge for cardiac arrest during the study period. We identified the basic characteristics including age, gender, race and admitting hospital status. The set primary outcome was inpatient mortality, length of stay (LOS) and total costs of admission. The secondary outcomes were the incidence of acute kidney injury, acute blood loss anemia, acute embolism and thrombosis of deep veins of lower extremity (DVT), pulmonary embolism, non-traumatic intracranial hemorrhage, and thromboembolic stroke. Multivariable logistic regression model analysis was performed to address potential confounders. The Charlson Comorbidity Index (CCI) was used to adjust for the severity of each patient's co-morbidities. Results A total of 44,655 patients was admitted for cardiac arrest during the study period. Mean age was 64 years; 56% were men; 63% were white, 20.7% were black, 9.2% were latino, 2.8% were Asian or pacific Islander. The total in-hospital mortality was 73.5%. The average length of stay was 4.2 days and the average total costs of admission was 83,516 dollars. Among the seven demographic characteristics: age, gender, race, hospital size, hospital region, hospital teaching status, insurance type; only hospital teaching status and hospital size were found to significantly impact the mortality. Acute kidney injury was the most common complication in post-cardiac arrest patient (42%), followed by acute blood loss anemia (3.6%), pulmonary embolism (2.3%) and DVT (2.1%). Thromboembolic stroke (0.2%) and non-traumatic intracranial hemorrhage (0.1%) are less common. During subgroup analysis, acute kidney injury was also found out to be a predictive factor of increased mortality (OR 1.64, p&lt;0.001). Conclusion Cardiac arrest remains one of the conditions with highest mortality rate. In our study, age, gender or race dit not impact on the outcome of cardiac arrest. Among all the complications from cardiac arrest, acute kidney injury was the most common one and was associated with higher mortality rate. FUNDunding Acknowledgement Type of funding sources: None.

Frequency and Treatment Outcomes of Isolated Ventricular Hemorrhage Cases Among Traumatic Intracranial Hemorrhage Patients

Background: Bleeding into the ventricular system of brain is called intraventricular hemorrhage (IVH). It may be associated with brain parenchyma. Cases of isolated ventricular hemorrhages are found less. Ventricular hemorrhage due to trauma is more commonly seen in premature babies and infants than adults. Uncertainty in recovery is a important issue for such cases. Aim of the study: The aim of this study was to evaluate the frequency and the treatment outcomes of isolated ventricular hemorrhage cases among patients with traumatic intracranial hemorrhage. Methods: This prospective observational study was directed in the neurosurgery department of Sylhet MAG Osmani Medical College, Sylhet, Bangladesh from January 2015 to December 2020. In total 890 Admitted diagnosed cases of traumatic intracranial hemorrhage were chosen for this study as study population. Ultrasonography CT scan, MRI of the brain, MRA, MRV, and CSF were performed according to the patient’s status. Those were collected, processed, analyzed, and disseminated by using MS office and SPSS version 23 as per need. Results: According to this study, in total participants, the highest number was with parenchymal hemorrhage which was 34% (n=302). Besides these, cases with extradural hemorrhage were 33% (n=298), cases with subdural hemorrhage were 17% (n=149%), cases with subarachnoid hemorrhage were 14% (n=124) and cases with isolated ventricular hemorrhage (IVH) were 2% (n=17). So, in this study, the frequency of IVH was found only 2% among all types of traumatic intracranial hemorrhage cases. Among a total of 17 IVH patients, most of the cases were infants or baby which was 59%. And 41% of the IVH patients were adults. In analyzing the outcomes among the IVH patients we observed, early recovery was found in 1 child (5.88%) and in 2 adults (11.76%). Besides these, death was occurred in 6 children (35.29%) and in 3 adults (17.65%). Conclusion: Traumatic isolated ventricular hemorrhage (IVH) causes the worst prognosis in most cases. The survival rate with no residual effect is very minimum. In this study in 2 patients’ history of long coma, for more than 12 weeks was found. Besides these, moderate to severe morbidity was found in some cases.