Title: The AHEAD Study: Managing anticoagulated patients who suffer head injury
Funder: Department of Health (England)

Abstract: Background There is poor evidence to support how anticoagulated patients should be managed when they suffer head injury. It is recognised there is increased risk from severe intracranial bleeding following head injury amongst these patients because of their coagulation status. Current practice is based on anecdotal evidence and not standardised across health communities. However, better evidence is required to determine the incidence of clinically significant complication and the clinical and cost effectiveness of current management strategies. In addition, in order to improve care this patient group, experiences and satisfaction with care received need to be evaluated along with robust research to identify predictors of adverse clinical outcomes and cost-effectiveness of different models of care.??? Aims This study aims to 1. Identify the outcomes of anticoagulated patients attending the emergency departments (ED) following head injury 2. Collect prospective data to enable the risk of clinically important brain injury to be calculated for this patient group 3. Use baseline and follow up data to identify useful predictors of adverse outcome in this patient group 4. Evaluate and model the cost-effectiveness of different clinical management strategies for this patient group 5. Document important factors in the clinical consultation and assessment process following head injury. Assess levels of satisfaction amongst anticoagulated patients following ED attendance with their head injury. Plan of Investigation This prospective study will recruit consecutive anticoagulated patients who attend following head injury from up to 9 EDs. Patients will be followed up for 6 weeks after injury to ascertain rate of complications, investigations, clinical management and health outcomes including mortality and quality of life. Data analysis will identify: •Incidence of clinically significant brain injury and of ongoing symptoms relating to the head injury •Identification of early predictors of adverse outcome including clinical features and investigations which may be useful as a diagnostic tool •Costs per patient as managed in the participating centres and when applied to a derived ‘ideal’ model •Patient satisfaction with initial management and acceptance and preference for different management strategies Potential Impact It is anticipated this will be the first multi-centre prospective study of anticoagulated patients suffering head injury, and will provide much needed guidance for emergency physicians and other healthcare professionals managing acute injury in these patients. The study will provide details on the cost and clinical outcome of these patients following head injury, the investigations and management strategies required in order to minimise the risk of complications. It will assess the value of early clinical and investigative factors in identifying patients most at risk from serious complication and model the costs of the most effective management strategy. It is anticipated that this study will lead on to further research by providing robust justification for a controlled study.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.3 MANAGEMENT AND DECISION MAKING
Health categories: INJURIES AND ACCIDENTS