{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T17:15:33Z","timestamp":1781198133771,"version":"3.54.1"},"reference-count":23,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T00:00:00Z","timestamp":1645747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The aim of this study was to retrospectively evaluate the risk of acute hemorrhagic complications in patients after either a decompressive craniectomy or a craniotomy sustaining a recurrent mild traumatic brain injury. Furthermore, we analyze whether there is a higher risk for acute hemorrhagic complications considering patients with anticoagulation compared with patients without anticoagulation in both groups. All patients with mild traumatic brain injuries after either decompressive craniectomy or craniotomy, treated between January 2005 and December 2020 at a single level 1 trauma center, were included in this retrospective analysis. Patients were screened for intracranial bleeding after mild traumatic brain injury with computed tomography. Additionally, the type of anticoagulation and its relationship concerning the clinical outcome were assessed. A total of 188 patients who had sustained a mild traumatic brain injury were included in the study. Overall, 22 patients (11.7%) presented intracranial lesions. A bony defect (decompressive craniectomy) was present in 31 patients (16.5%). In 157 patients (83.5%) who underwent decompressive craniectomy, the bony defect was closed during a second operation. There was no significant correlation between both groups on the occurrence of intracranial bleeding (p = 0.216). Furthermore, no difference was present between patients with and without anticoagulation (p = 0.794) concerning acute hemorrhagic complications after recurrent traumatic brain injury. Pre-existing bony defects after decompressive craniectomy showed no higher risk for acute hemorrhagic complications after recurrent mild traumatic brain injury compared with patients who primarily underwent craniotomy. Anticoagulation did not influence the occurrence of intracranial bleeding after mild traumatic brain injury in patients with decompressive craniectomy.<\/jats:p>","DOI":"10.3390\/ijerph19052684","type":"journal-article","created":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T10:00:40Z","timestamp":1645783240000},"page":"2684","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Patients with Prior Craniectomy or Craniotomy Have No Increased Risk of Acute Hemorrhage after Mild Traumatic Brain Injury"],"prefix":"10.3390","volume":"19","author":[{"given":"Harald","family":"Binder","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7081-7505","authenticated-orcid":false,"given":"Daniel","family":"Schallmeiner","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8698-8341","authenticated-orcid":false,"given":"Thomas M.","family":"Tiefenboeck","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Payr","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Winnisch","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Sacred Heart Hospital of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Kdolsky","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Hajdu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6434-0520","authenticated-orcid":false,"given":"Gilbert Manuel","family":"Schwarz","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Hofbauer","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"341","DOI":"10.3233\/NRE-2007-22502","article-title":"The impact of traumatic brain injuries: A global perspective","volume":"22","author":"Hyder","year":"2007","journal-title":"NeuroRehabilitation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s00701-005-0651-y","article-title":"A systematic review of brain injury epidemiology in Europe","volume":"148","author":"Tagliaferri","year":"2006","journal-title":"Acta Neurochir."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1136\/jnnp-2013-307279","article-title":"Mortality and morbidity 15 years after hospital admission with mild head injury: A prospective case-controlled population study","volume":"85","author":"McMillan","year":"2014","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1007\/s00508-013-0456-6","article-title":"Epidemiology of traumatic brain injury in Austria","volume":"126","author":"Mauritz","year":"2014","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_5","first-page":"105","article-title":"Treating persons with traumatic brain injury: History and updates","volume":"76","author":"Niemeier","year":"2015","journal-title":"N. Carol. Med. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1007\/s00115-015-0051-3","article-title":"Traumatic brain injury","volume":"87","author":"Hackenberg","year":"2016","journal-title":"Nervenarzt"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1111\/j.1532-5415.2006.00894.x","article-title":"Traumatic brain injury in older adults: Epidemiology, outcomes, and future implications","volume":"54","author":"Thompson","year":"2006","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Perel, P., Roberts, I., Bouamra, O., Woodford, M., Mooney, J., and Lecky, F. (2009). Intracranial bleeding in patients with traumatic brain injury: A prognostic study. BMC Emerg. Med., 9.","DOI":"10.1186\/1471-227X-9-15"},{"key":"ref_9","first-page":"60","article-title":"Decompressive Craniectomy and Traumatic Brain Injury: A Review","volume":"1","year":"2013","journal-title":"Bull. Emerg. Trauma"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1016\/j.jcms.2015.08.003","article-title":"Autologous cranial bone graft use for trepanation reconstruction","volume":"43","author":"Worm","year":"2015","journal-title":"J Cranio-Maxillofac. Surg."},{"key":"ref_11","first-page":"103","article-title":"Dekompressive Kraniektomie in der Neurotraumatologie","volume":"16","author":"Anton","year":"2015","journal-title":"J. Neurol. Neurochir. Psychiatr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"22","DOI":"10.13004\/kjnt.2016.12.1.22","article-title":"Craniotomy or Decompressive Craniectomy for Acute Subdural Hematomas: Surgical Selection and Clinical Outcome","volume":"12","author":"Kwon","year":"2016","journal-title":"Korean J. Neurotrauma"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2878","DOI":"10.1007\/s00415-019-09541-4","article-title":"Recent advances in traumatic brain injury","volume":"266","author":"Khellaf","year":"2019","journal-title":"J. Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1016\/S0003-9993(03)00287-9","article-title":"Outcome 3 to 5 years after moderate to severe traumatic brain injury","volume":"84","author":"Dikmen","year":"2003","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"453978","DOI":"10.1155\/2013\/453978","article-title":"What is the incidence of intracranial bleeding in patients with mild traumatic brain injury? A retrospective study in 3088 Canadian CT head rule patients","volume":"2013","author":"Albers","year":"2013","journal-title":"BioMed Res. Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"760","DOI":"10.3171\/2013.3.JNS12503","article-title":"Dabigatran bleed risk with closed head injuries: Are we prepared?","volume":"119","author":"Parra","year":"2013","journal-title":"J. Neurosurg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.annemergmed.2011.12.003","article-title":"Management of minor head injury in patients receiving oral anticoagulant therapy: A prospective study of a 24-hour observation protocol","volume":"59","author":"Menditto","year":"2012","journal-title":"Ann. Emerg. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.annemergmed.2012.04.007","article-title":"Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and preinjury warfarin or clopidogrel use","volume":"59","author":"Nishijima","year":"2012","journal-title":"Ann. Emerg. Med."},{"key":"ref_19","first-page":"1600","article-title":"Delayed intracranial hemorrhage after blunt trauma: Are patients on preinjury anticoagulants and prescription antiplatelet agents at risk?","volume":"71","author":"Peck","year":"2011","journal-title":"J. Trauma"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Antoni, A., Schwendenwein, E., Binder, H., Schauperl, M., Datler, P., and Hajdu, S. (2019). Delayed Intracranial Hemorrhage in Patients with Head Trauma and Antithrombotic Therapy. J. Clin. Med., 8.","DOI":"10.3390\/jcm8111780"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1016\/j.annemergmed.2008.08.021","article-title":"Clinical policy: Neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting","volume":"52","author":"Jagoda","year":"2008","journal-title":"Ann. Emerg. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e013742","DOI":"10.1136\/bmjopen-2016-013742","article-title":"Should all anticoagulated patients with head injury receive a CT scan? Decision-analysis modelling of an observational cohort","volume":"6","author":"Kuczawski","year":"2016","journal-title":"BMJ Open"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Unden, J., Ingebrigtsen, T., Romner, B., and Scandinavian Neurotrauma, C. (2013). Scandinavian guidelines for initial management of minimal, mild and moderate head injuries in adults: An evidence and consensus-based update. BMC Med., 11.","DOI":"10.1186\/1741-7015-11-50"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/5\/2684\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:27:28Z","timestamp":1760135248000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/5\/2684"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,25]]},"references-count":23,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["ijerph19052684"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19052684","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,25]]}}}