{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T04:46:58Z","timestamp":1784609218100,"version":"3.55.0"},"reference-count":17,"publisher":"Ordem dos Medicos","issue":"1","license":[{"start":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T00:00:00Z","timestamp":1735776000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Med Port"],"abstract":"<jats:p>Introduction: According to the Portuguese clinical guidelines published in 1999, patients with traumatic brain injury and coagulopathies should remain in-hospital for 24 hours for clinical and image surveillance, despite having an admission computed tomography (CT) scan showing no intracranial lesions. Growing evidence suggests this practice is not only void of clinical relevance, but that it can also be potentially harmful for the patient. Nevertheless, upuntil now there is no published data concerning the economic impact of this clinical practice. Methods: A cost analysis compared retrospective data from patients admitted to our emergency department during 2022 with a hypothetical scenario in which a patient with an admission CT scan without traumatic lesions was discharged. Clinical data was also retrieved concerning the rate of a delayed intracranial bleeding on 24-hour CT scan and mortality at a six-month-period after discharge. Direct costs for the national health service were determined in terms of funding and time invested by medical teams.Results: From a sample of 440 patients, 436 remained in-hospital for a 24-hour clinical and image surveillance, of which only two (0.5%) showed a new intracranial lesion on the second CT-scan. Neither of these two patients required therapeutic measures to control bleeding and were discharged 36 hours after admission. Out of 440 patients, one patient (0.2%) died of cardiac arrest during the 24-hour surveillance period, despite having an initial normalCT scan showing no brain lesions. Our current surveillance practice directly amounted to \u20ac163 157.00, whereas the cost of our hypothetical scenario amounted to \u20ac29 480.00: a difference of \u20ac133 677.00. The application of our surveillance guideline also meant that nine emergency shifts were devoted to this task, compared to 4.6 hypothetical shifts if patients were discharged after an initial CT scan without traumatic intracranial lesions.Conclusion: In spite of apparently not adding any clinical value to our practice, our in-hospital surveillance may represent a significant financial and time-consuming burden, costing five times as much and demanding our medical teams twice as much work when compared to a scenario without clinical surveillance and 24-hour CT scans.<\/jats:p>","DOI":"10.20344\/amp.21661","type":"journal-article","created":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T11:44:28Z","timestamp":1735818268000},"page":"16-22","source":"Crossref","is-referenced-by-count":2,"title":["Economic Impact of Surveillance of Head Trauma Patients with Coagulopathy and Normal Initial Computed Tomography Scan (ECO-NCT)"],"prefix":"10.20344","volume":"38","author":[{"given":"Tiago","family":"Ribeiro da Costa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1822-5649","authenticated-orcid":false,"given":"Rodrigo","family":"Batata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3799-1608","authenticated-orcid":false,"given":"Susana","family":"Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6602-8608","authenticated-orcid":false,"given":"Armindo","family":"Fernandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9rgio","family":"Sousa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filipe","family":"Vaz Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9844-8166","authenticated-orcid":false,"given":"Vasco","family":"S\u00e1 Pinto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7970-5577","authenticated-orcid":false,"given":"M\u00e1rcia","family":"Tizziani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5133-6207","authenticated-orcid":false,"given":"Eduardo","family":"Cunha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5954-8104","authenticated-orcid":false,"given":"Alfredo","family":"Calheiros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"8464","published-online":{"date-parts":[[2025,1,2]]},"reference":[{"key":"7769","unstructured":"Dire\u00e7\u00e3o-Geral da Sa\u00fade. Protocolo nacional para a abordagem dos traumatismos cr\u00e2neo-encef\u00e1licos. 1999. [cited 2024 Aug 21]. Available from: https:\/\/www.dgs.pt\/directrizes-da-dgs\/normas-e-circularesnormativas\/ circular-normativa-n-05gabdg-de-05051999-pdf.aspx."},{"key":"7770","doi-asserted-by":"crossref","unstructured":"Vos PE, Battistin L, Birbamer G, Gerstenbrand F, Potapov A, PrevecT, et al. EFNS guideline on mild traumatic brain injury: report of an EFNS task force. Eur J Neurol. 2002;9:207-19.","DOI":"10.1046\/j.1468-1331.2002.00407.x"},{"key":"7771","doi-asserted-by":"crossref","unstructured":"Vos PE, Alekseenko Y, Battistin L, Ehler E, Gerstenbrand F, Muresanu DF, et al. Mild traumatic brain injury: mild traumatic brain injury. Eur J Neurol. 2012;19:191-8.","DOI":"10.1111\/j.1468-1331.2011.03581.x"},{"key":"7772","doi-asserted-by":"crossref","unstructured":"Duarte-Batista P, Farinha NC, Marques R, P\u00e1scoa Pinheiro J, Silva J, Tuna R, et al. HIPTCN: prospective observational study of hypocoagulated head trauma patients with normal admission computed tomography scan. Acta Med Port. 2021;34:413-9.","DOI":"10.20344\/amp.13770"},{"key":"7773","doi-asserted-by":"crossref","unstructured":"Lagares A, Casta\u00f1o-Leon AM, Richard M, Tsitsopoulos PP, Morales J, Mihai P, et al. Variability in the indication of brain CT scan after mild traumatic brain injury. A transnational survey. Eur J Trauma Emerg Surg. 2023;49:1189-98.","DOI":"10.1007\/s00068-022-01902-5"},{"key":"7774","doi-asserted-by":"crossref","unstructured":"Turcato G, Cipriano A, Zaboli A, Park N, Riccardi A, Santini M, et al. Risk of delayed intracranial haemorrhage after an initial negative CT in patients on DOACs with mild traumatic brain injury. Am J Emerg Med. 2022;53:185-9.","DOI":"10.1016\/j.ajem.2022.01.018"},{"key":"7775","doi-asserted-by":"crossref","unstructured":"Hadwe SE, Assamadi M, Barrit S, Giannis D, Haidich AB, Goulis DG, et al. Delayed intracranial hemorrhage of patients with mild traumatic brain injury under antithrombotics on routine repeat CT scan: a systematic review and meta-analysis. Brain Inj. 2022;36:703-13.","DOI":"10.1080\/02699052.2022.2065034"},{"key":"7776","unstructured":"Covino M, Manno A, Della Pepa GM, Piccioni A, Tullo G, Petrucci M, et al. Delayed intracranial hemorrhage after mild traumatic brain injury in patients on oral anticoagulants: is the juice worth the squeeze? Eur Rev Med Pharmacol Sci. 2021;25:3066-73."},{"key":"7777","doi-asserted-by":"crossref","unstructured":"Antoni A, Wedrich L, Schauperl M, H\u00f6chtl-Lee L, Sigmund IK, Gregori M, et al. Management of traumatic brain injury in patients with DOAC therapy\u2013are the \u201cnew\u201d oral anticoagulants really safer? J Clin Med. 2022;11:6268.","DOI":"10.3390\/jcm11216268"},{"key":"7778","doi-asserted-by":"crossref","unstructured":"Wang S, Meagher M, Mullin E, Brown C, Skicki EJ. Routine repeat imaging is unnecessary for coagulopathic patients sustaining head trauma. Am Surg. 2022;88:1754-9.","DOI":"10.1177\/00031348221083935"},{"key":"7779","doi-asserted-by":"crossref","unstructured":"Leitner L, El-Shabrawi JH, Bratschitsch G, Eibinger N, Klim S, Leithner A, et al. Risk adapted diagnostics and hospitalization following mild traumatic brain injury. Arch Orthop Trauma Surg. 2021;141:619-27.","DOI":"10.1007\/s00402-020-03545-w"},{"key":"7780","doi-asserted-by":"crossref","unstructured":"Turcato G, Cipriano A, Park N, Zaboli A, Ricci G, Riccardi A, et al. Decision tree analysis for assessing the risk of post-traumatic haemorrhage after mild traumatic brain injury in patients on oral anticoagulant therapy. BMC Emerg Med. 2022;22:47.","DOI":"10.1186\/s12873-022-00610-y"},{"key":"7781","doi-asserted-by":"crossref","unstructured":"Cipriano A, Park N, Pecori A, Bionda A, Bardini M, Frassi F, et al. Predictors of post-traumatic complication of mild brain injury in anticoagulated patients: DOACs are safer than VKAs. Intern Emerg Med. 2021;16:1061-70.","DOI":"10.1007\/s11739-020-02576-w"},{"key":"7782","doi-asserted-by":"crossref","unstructured":"Turcato G, Zaboli A, Zannoni M, Ricci G, Zorzi E, Ciccariello L, et al. Risk factors associated with intracranial bleeding and neurosurgery in patients with mild traumatic brain injury who are receiving direct oral anticoagulants. Am J Emerg Med. 2021;43:180-5.","DOI":"10.1016\/j.ajem.2020.02.046"},{"key":"7783","doi-asserted-by":"crossref","unstructured":"Fuller G, Sabir L, Evans R, Bradbury D, Kuczawski M, Mason SM. Risk of significant traumatic brain injury in adults with minor head injury taking direct oral anticoagulants: a cohort study and updated meta-analysis. Emerg Med J. 2020;37:666-73.","DOI":"10.1136\/emermed-2019-209307"},{"key":"7784","doi-asserted-by":"crossref","unstructured":"Rudmik L, Drummond M. Health economic evaluation: Important principles and methodology. Laryngoscope. 2013;123:1341-7.","DOI":"10.1002\/lary.23943"},{"key":"7785","unstructured":"Portugal. Portaria n.\u00ba 254\/2018. Di\u00e1rio da Rep\u00fablica, I S\u00e9rie, n.\u00ba 173 (2018\/09\/07). p.4497-706. 18. Sociedade Portuguesa de Neurocirurgia. Servi\u00e7os de neurocirurgia em Portugal. [cited 2024 Aug 21]. 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