Timing of pharmacological venous thromboembolism prophylaxis after firearm-related penetrating brain injury
Notice bibliographique
Résumé
OBJECTIVE: Mounting evidence supports early initiation of pharmacological venous thromboembolism (VTE) prophylaxis after traumatic brain injury. However, the effectiveness and safety of VTE prophylaxis after penetrating brain injury (PBI) is unclear. The objective of this study was to evaluate the effectiveness and safety of pharmacological VTE prophylaxis in patients with firearm-related PBI. METHODS: This was a retrospective cohort study of patients aged ≥ 16 years with isolated firearm-related PBI treated at level I or II trauma centers participating in the American College of Surgeons Trauma Quality Improvement Program (2017-2019). The exposure was the timing of VTE prophylaxis initiation measured in days from admission (prophylaxis delay). The primary outcome was VTE. Secondary outcomes were the need for late neurosurgical decompression (craniotomy/craniectomy after 48 hours) and in-hospital mortality. Hierarchical logistic regression estimated the association between prophylaxis delay and the outcomes after adjusting for patient baseline and injury characteristics. Effect modification was tested to determine if observed associations varied by type of early neurosurgical intervention: craniotomy/craniectomy, intracranial monitor/drain placement, or no intervention. RESULTS: The authors identified 2012 patients with isolated firearm-related PBI. The median presenting Glasgow Coma Scale score was 8 (IQR 3-14) and 31% had an abnormal pupillary response. Nearly half of the cohort received early neurosurgical intervention (craniotomy/craniectomy, 40%; intracranial monitor/drain, 8%). The median VTE prophylaxis delay was 3 days (IQR 2-5 days). VTE occurred in 6% of patients. Overall, late neurosurgical decompression was required in 9%, and 10% died. After risk adjustment, each additional day of prophylaxis delay was associated with 6% increased odds of VTE (OR 1.06 per day, 95% CI 1.02-1.11). However, the association between timing of prophylaxis and late neurosurgical decompression depended on type of early neurosurgical intervention. Specifically, each day of prophylaxis delay was associated with decreased odds of late decompression among patients who underwent intracranial monitor/drain only (OR 0.51, 95% CI 0.35-0.75) or no intervention (OR 0.85, 95% CI 0.75-0.95). Timing of prophylaxis was not associated with late neurosurgical decompression for patients who underwent early craniotomy/craniectomy. There was no association with in-hospital mortality. CONCLUSIONS: Among patients with firearm-related PBI, earlier pharmacological prophylaxis was associated with decreased odds of VTE. However, earlier prophylaxis was also associated with late neurosurgical decompression among patients who underwent intracranial monitor/drain placement or no intervention, an effect not observed for patients who underwent early craniotomy/craniectomy. These findings suggest that while early prophylaxis should be prioritized, prospective study is needed to clarify safe timing of initiation in different patient groups.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».