• Gianni Turcato, Arian Zaboli, Massimo Zannoni, Giorgio Ricci, Elisabetta Zorzi, Laura Ciccariello, Andrea Tenci, Norbert Pfeifer, Antonio Maccagnani, and Antonio Bonora.
• Department of Emergency Medicine, Franz Tappeiner Hospital of Merano, Azienda Sanitaria dell'Alto Adige, Merano, Bolzano, Italy. Electronic address: gianni.turcato@yahoo.it.
• Am J Emerg Med. 2021 May 1; 43: 180-185.

BackgroundThe established clinical risk factors for post-traumatic intracranial bleeding have not been evaluated in patients receiving DOACs yet.AimEvaluating the association between clinic and patient characteristics and post-traumatic intracranial bleeding (ICH) in patients with mild traumatic brain injury (MTBI) and DOACs.MethodsThis is a retrospective observational study conducted on three Emergency Departments. Multivariate analysis provided association in terms of OR with the risk of ICH. The performance of the multivariate model, described in a nomogram, has been tested with discrimination and decision curve analysis.ResultsOf 473 DOACs patients with MTBI, 8.5% had post-traumatic ICH. On multivariable analysis, major dynamics (odds ratio [OR] 6.255), post-traumatic amnesia (OR 3.961), post-traumatic loss of consciousness (LOC, OR 7.353), Glasgow Coma Scale (GCS) score < 15 (OR 3.315), post-traumatic headache (OR 4.168) and visible trauma above the clavicles (OR 3.378) were associated with a higher likelihood of ICH. The multivariate model, used for the nomogram construction, showed a good performance (AUC bias corrected with 5000 bootstraps resample 0.78). The DCAs showed a net clinical benefit of the prognostic model.ConclusionsClinical risk factors can be used in DOACs patients to better define the risk of post-traumatic ICH.Copyright © 2020 Elsevier Inc. All rights reserved.

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