Regional differences in the management of patients with mild traumatic brain injury and antithrombotic therapy-an Austrian survey

BACKGROUND/PURPOSE: The number of patients with mild traumatic brain injury (TBI) receiving oral anticoagulation is increasing. Up-to-date diagnostic and treatment algorithms are missing in Austria. The aim of this survey is to collect and analyse Austria-wide data on the care of this patient group.

METHODS: The survey was carried out using "Jotform" between 27 November 2023 and 31 January 2024, asking questions relating to the diagnosis and treatment of patients with mild TBI receiving antithrombotic therapy. Patient groups comprising individuals with alcohol addiction and hemophilia were incorporated as well with a view to the paucity of available literature on these groups. The survey was sent to all orthopedic-traumatological and neurosurgical departments in Austria.

RESULTS: 39 of 67 (58.2%) orthopedics & traumatology departments and 4 of 10 (40%) neurosurgery departments participated in the survey. The share of departments reporting routine submission of different patient groups to cranial computed tomography (CCT) was 38 (95%) for patients taking antiplatelet agents, 39 (97.5%) departments for patients taking vitamin K antagonists (VKAs), 39 (97.5%) for patients taking direct oral anticoagulants (DOACs), 11 (27.5%) for patients with alcohol addiction, and 28 (70%) for patients with known hemophilia. Considering the separate groups of patients not living in a nursing facility vs. those living in a nursing facility, inpatient admission occurred for 63% vs. 44% of patients taking antiplatelet agents, for 78% vs. 61% of patients taking VKAs, 80.5% vs. 63.4% of patients taking DOACs, 17.1% vs. 17% of patients with alcohol addiction, and 51.2% vs. 43.9% of patients with hemophilia. Statistically significant regional differences in inpatient admission were found in the group with hemophilia (living and not living in a nursing facility) as well as in the group with DOAC intake (living in a nursing facility).

CONCLUSIONS: Regional differences in the treatment of the studied patient groups exist within Austria, particularly regarding in-house admission of patients. An up-to-date guideline would be desirable to enable the best possible patient care while taking the increasing resource scarcity into account.