Platelet Inhibitor Treated Patients With Head Injury Trauma Meeting NICE Criteria : is the CT-scan Mandatory ?

Study Overview
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Brief Summary
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At the emergencies rooms, patients with head trauma meeting one of the NICE criteria, which include antiplatelet inhibitors treatment, are considered as patients with a risk of cerebral haemorrage and are taken systematically for a CT-scanner. However, there are more and more antiplatelet inhibitor's patient with minor head injury traumas seen at the emergencies room and the efficiency of this NICE criteria is controversial on litterature. This study aims to determine that the absence of no other NICE criteria than antiplatelet inhibitors is a sufficient condition to eliminate a cerebral haemorrhage for patients with head injury traumas, and conversely, that antiplatelet inhibitors treatment would not be by itself an indication for a CT-scanner.

Detailed Description
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Head injuries are a frequent reason for emergency services, and according to studies, they represent between 5% and 10% of patients treated in emergencies. Among them, 90% are minor head injury traumas. NICE criteria has been defined to establish patients who need a CT-scanner because of a risk of cerebral haemorrhage. NICE criteria include several conditions including taking antiplatelet inhibitors. However, the real risk of cerebral haemorrhage for theses cases is controversial in litterature. In parallel, more and more patients undergoing antiplatelet inhibitor's treatment are seen in emergencies after a head injury trauma. In routine protocol at the emergency rooms, these patients are seen for a clinical exam and next submitted to a CT-scanner. If the clinician can't detect a cerebral haemorrage, the patient will return at home. This study aims to determine that the absence of no other NICE criteria than antiplatelet inhibitors treatment is a sufficient condition to eliminate a cerebral haemorrhage for patients with head injury traumas, and conversely, that antiplatelet inhibitors treatment would not be by itself an indication for a CT-scanner. This is a diagnostic, case-only, prospective, multicenter study with a blinded primary outcome measure assessment. As described in routine protocol, in this study antiplatelet inhibitor's patients with head injury trauma will be seen for a clinical exam and next submitted to a CT-scanner. After a month, patient will be called by the clinical center to ask about morbidity and mortality. Especially, clinicans will report on the emergence of a cerebral haemorrhage during this month.

Official Title
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Platelet Inhibitor Treated Patients With Head Injury Trauma Without Any Clinical Symptoms of Cerebral Haemorrhage (NICE Criteria) : is the CT-scan Mandatory ?

Conditions
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Head Injury Trauma, Emergencies

Intervention / Treatment
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* Radiation: CT-scanner


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: At least 18 years old Patient with a head injury trauma, described by the patient or seen at the clinical exam Glasgow score between 13 and 15 at the clinical exam Current treatment with antiplatelet inhibitors Informed non opposition form signed Exclusion Criteria : - Absence of CT-scanner

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patient with minor head injury trauma<br>The emergency protocol for antiplatelet inhibitors treated patient with head injury trauma and meeting others NICE criteria involves a clinical exam followed by a CT-scanner. | Radiation: CT-scanner<br>* After a clinical exam, patient have a CT-scanner to check any cerebral haemorrhage.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Existence of a cerebral haemorrhage at the CT-scanner. | Cerebral haemorrhage seen at the CT-scanner. | 1 day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neurosurgeries' rate after one month | Neurosurgeries' rate after one month | 1 month | 
| Existence of a cerebral haemorrhage associated to death | Existence of a cerebral haemorrhage associated to death | 1 month | 
| Existence of a cerebral haemorrhage associated to neurosurgery | Existence of a cerebral haemorrhage associated to neurosurgery | 1 month | 
| Existence of a cerebral haemorrhage associated to hospitalization with more than 24h of intubation | Existence of a cerebral haemorrhage associated to hospitalization with more than 24h of intubation | 1 month | 
| Existence of a cerebral haemorrhage associated to more than 2 nights at hospital | Existence of a cerebral haemorrhage associated to more than 2 nights at hospital | 1 month | 
| Death rate after one month | Death rate after one month | 1 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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emergencies, platelet inhibitors, minor head injury trauma, CT-scan