“Decision tree analysis for assessing the risk of post-traumatic haemorrhage after mild traumatic brain injury in patients on oral anticoagulant therapy”
Abstract Background 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...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-03-01
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| Series: | BMC Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12873-022-00610-y |
| _version_ | 1811332152115068928 |
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| author | Gianni Turcato Alessandro Cipriano Naria Park Arian Zaboli Giorgio Ricci Alessandro Riccardi Greta Barbieri Sara Gianpaoli Grazia Guiddo Massimo Santini Norbert Pfeifer Antonio Bonora Ciro Paolillo Roberto Lerza Lorenzo Ghiadoni |
| author_facet | Gianni Turcato Alessandro Cipriano Naria Park Arian Zaboli Giorgio Ricci Alessandro Riccardi Greta Barbieri Sara Gianpaoli Grazia Guiddo Massimo Santini Norbert Pfeifer Antonio Bonora Ciro Paolillo Roberto Lerza Lorenzo Ghiadoni |
| author_sort | Gianni Turcato |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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. Conclusions 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. |
| first_indexed | 2024-04-13T16:32:25Z |
| format | Article |
| id | doaj.art-6bb83649b4284b788e7caa090b9a8141 |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-04-13T16:32:25Z |
| publishDate | 2022-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-6bb83649b4284b788e7caa090b9a81412022-12-22T02:39:32ZengBMCBMC Emergency Medicine1471-227X2022-03-0122111010.1186/s12873-022-00610-y“Decision tree analysis for assessing the risk of post-traumatic haemorrhage after mild traumatic brain injury in patients on oral anticoagulant therapy”Gianni Turcato0Alessandro Cipriano1Naria Park2Arian Zaboli3Giorgio Ricci4Alessandro Riccardi5Greta Barbieri6Sara Gianpaoli7Grazia Guiddo8Massimo Santini9Norbert Pfeifer10Antonio Bonora11Ciro Paolillo12Roberto Lerza13Lorenzo Ghiadoni14Emergency Department, Hospital of Merano (SABES-ASDAA)Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria PisanaEmergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria PisanaEmergency Department, Hospital of Merano (SABES-ASDAA)Emergency Department, University of VeronaEmergency Department, Hospital of San Paolo (ASL N°2 Savonese)Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria PisanaEmergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria PisanaEmergency Department, Hospital of San Paolo (ASL N°2 Savonese)Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria PisanaEmergency Department, Hospital of Merano (SABES-ASDAA)Emergency Department, University of VeronaEmergency Department, University of VeronaAcademy of Emergency Medicine and Care (AcEMC)Academy of Emergency Medicine and Care (AcEMC)Abstract Background 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. Methods 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. Results 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. Conclusions 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.https://doi.org/10.1186/s12873-022-00610-yMild traumatic brain injuryMinor head injuryRisk factorsOral anticoagulantsAnticoagulationEmergency department |
| spellingShingle | Gianni Turcato Alessandro Cipriano Naria Park Arian Zaboli Giorgio Ricci Alessandro Riccardi Greta Barbieri Sara Gianpaoli Grazia Guiddo Massimo Santini Norbert Pfeifer Antonio Bonora Ciro Paolillo Roberto Lerza Lorenzo Ghiadoni “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 Mild traumatic brain injury Minor head injury Risk factors Oral anticoagulants Anticoagulation Emergency department |
| title | “Decision tree analysis for assessing the risk of post-traumatic haemorrhage after mild traumatic brain injury in patients on oral anticoagulant therapy” |
| title_full | “Decision tree analysis for assessing the risk of post-traumatic haemorrhage after mild traumatic brain injury in patients on oral anticoagulant therapy” |
| title_fullStr | “Decision tree analysis for assessing the risk of post-traumatic haemorrhage after mild traumatic brain injury in patients on oral anticoagulant therapy” |
| title_full_unstemmed | “Decision tree analysis for assessing the risk of post-traumatic haemorrhage after mild traumatic brain injury in patients on oral anticoagulant therapy” |
| title_short | “Decision tree analysis for assessing the risk of post-traumatic haemorrhage after mild traumatic brain injury in patients on oral anticoagulant therapy” |
| title_sort | decision tree analysis for assessing the risk of post traumatic haemorrhage after mild traumatic brain injury in patients on oral anticoagulant therapy |
| topic | Mild traumatic brain injury Minor head injury Risk factors Oral anticoagulants Anticoagulation Emergency department |
| url | https://doi.org/10.1186/s12873-022-00610-y |
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