“Decision tree analysis for assessing the risk of post-traumatic haemorrhage after mild traumatic brain injury in patients on oral anticoagulant therapy”

BMC Emergency Medicine - Tập 22 - Trang 1-10 - 2022
Gianni Turcato1, Alessandro Cipriano2, Naria Park2, Arian Zaboli1, Giorgio Ricci3,4, Alessandro Riccardi5, Greta Barbieri2, Sara Gianpaoli2, Grazia Guiddo5, Massimo Santini2, Norbert Pfeifer1, Antonio Bonora3, Ciro Paolillo3,4, Roberto Lerza4,5, Lorenzo Ghiadoni4,6
1Emergency Department, Hospital of Merano (SABES-ASDAA), Merano, Italy
2Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
3Emergency Department, University of Verona, Verona, Italy
4Academy of Emergency Medicine and Care (AcEMC), Pavia, Italy
5Emergency Department, Hospital of San Paolo (ASL N°2 Savonese), Savona, Italy
6Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

Tóm tắt

The presence of oral anticoagulant therapy (OAT) alone, regardless of patient condition, is an indication for CT imaging in patients with mild traumatic brain injury (MTBI). Currently, no specific clinical decision rules are available for OAT patients. The aim of the study was to identify which clinical risk factors easily identifiable at first ED evaluation may be associated with an increased risk of post-traumatic intracranial haemorrhage (ICH) in OAT patients who suffered an MTBI. Three thousand fifty-four patients in OAT with MTBI from four Italian centers were retrospectively considered. A decision tree analysis using the classification and regression tree (CART) method was conducted to evaluate both the pre- and post-traumatic clinical risk factors most associated with the presence of post-traumatic ICH after MTBI and their possible role in determining the patient’s risk. The decision tree analysis used all clinical risk factors identified at the first ED evaluation as input predictor variables. ICH following MTBI was present in 9.5% of patients (290/3054). The CART model created a decision tree using 5 risk factors, post-traumatic amnesia, post-traumatic transitory loss of consciousness, greater trauma dynamic, GCS less than 15, evidence of trauma above the clavicles, capable of stratifying patients into different increasing levels of ICH risk (from 2.5 to 61.4%). The absence of concussion and neurological alteration at admission appears to significantly reduce the possible presence of ICH. The machine-learning-based CART model identified distinct prognostic groups of patients with distinct outcomes according to on clinical risk factors. Decision trees can be useful as guidance in patient selection and risk stratification of patients in OAT with MTBI.

Tài liệu tham khảo

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