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craneal en los pacientes con TCEL y al menos un factor de riesgo&#44; con un nivel de evidencia tipo A<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">4&#8211;8</span></a>&#46; Respecto al tiempo de observaci&#243;n tras un TCEL&#44; el nivel de evidencia es menor &#40;nivel C&#41;&#44; recomendando un periodo de observaci&#243;n entre 12 y 24 <span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">h</span> a&#250;n con TC craneal inicial normal<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">9&#8211;12</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Por lo tanto&#44; actualmente no disponemos de suficiente evidencia sobre el tiempo necesario de observaci&#243;n en pacientes con TCEL&#44; as&#237; como la necesidad de repetir una nueva prueba de neuroimagen&#46; La falta de evidencia se hace a&#250;n mayor en los pacientes tratados con anticoagulantes orales de acci&#243;n directa&#44; 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100<span class="elsevierStyleHsp" style=""></span>mg para AAS&#44; 75<span class="elsevierStyleHsp" style=""></span>mg para el clopidogrel y 90<span class="elsevierStyleHsp" style=""></span>mg para ticagrelor&#46; Los pacientes con anticoagulantes de acci&#243;n directa &#40;ACOD&#41; recibieron la dosis descoagulante seg&#250;n la funci&#243;n renal que indica la ficha t&#233;cnica de cada f&#225;rmaco&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A todos los pacientes con TCEL y uno o m&#225;s factores de riesgo se les realiz&#243; una TC craneal al ingreso acorde a las gu&#237;as actuales&#46; A las 24<span class="elsevierStyleHsp" style=""></span>h de observaci&#243;n&#44; se repiti&#243; una nueva TC craneal en aquellos casos con hemorragia inicial o deterioro neurol&#243;gico&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En los pacientes con hemorragia cerebral y tratamiento con acenocumarol e INR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1&#44;3 o en tratamiento con ACOD&#44; se les administr&#243; 10<span class="elsevierStyleHsp" style=""></span>mg de vitamina K y complejo protromb&#237;nico seg&#250;n la posolog&#237;a recomendada en ficha t&#233;cnica del f&#225;rmaco&#44; con el fin de obtener un INR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#44;3&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El tratamiento antitromb&#243;tico se reinici&#243; seg&#250;n criterio cl&#237;nico en funci&#243;n del riesgo tromb&#243;tico y el tipo de hemorragia<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A las 24<span class="elsevierStyleHsp" style=""></span>h de observaci&#243;n&#44; todos los pacientes fueron evaluados cl&#237;nicamente&#46; Se consider&#243; empeoramiento cl&#237;nico&#44; el descenso de un punto en la escala de Glasgow respecto al valor basal&#44; aparici&#243;n de cl&#237;nica neurol&#243;gica no presente al ingreso o empeoramiento de la misma&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Se recogieron datos demogr&#225;ficos&#44; factores de riesgo&#44; hemorragia en la TC craneal y n&#250;mero de reingresos hospitalarios por hemorragia cerebral en los siguientes 3 meses&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">An&#225;lisis estad&#237;stico</span><p id="par0075" class="elsevierStylePara elsevierViewall">Todos los datos fueron incluidos en el programa <span class="elsevierStyleItalic">Statistical Analysis System</span> &#40;SAS&#41;&#44; en su versi&#243;n 9&#46;3&#46; Se realiz&#243; un an&#225;lisis de estad&#237;stica descriptiva para todas las variables&#46; Las variables continuas se describieron mediante el n&#250;mero de casos v&#225;lidos&#44; media&#44; desviaci&#243;n est&#225;ndar &#40;DE&#41;&#44; mediana y rangos intercuart&#237;licos&#46; Las variables categ&#243;ricas mediante frecuencias absolutas y relativas de cada categor&#237;a sobre el total de valores v&#225;lidos &#40;N&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Las comparaciones de las variables categ&#243;ricas se han realizado utilizando el procedimiento ANOVA&#44; el test de Chi-cuadrado o la prueba exacta de Fisher seg&#250;n aplicara&#46; En el caso de las variables continuas se utiliz&#243; la prueba de la t de Student para datos independientes o la prueba de la U de Mann-Whitney dependiendo del tipo de datos&#46; Para evaluar los predictores independientes de hemorragia cerebral&#44; se realiz&#243; un an&#225;lisis multivariado con aquellas variables con una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 en el an&#225;lisis univariado&#46; Para todas las comparaciones se consider&#243; un nivel de significaci&#243;n estad&#237;stica de 0&#44;05 bilateral&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">Se incluyeron un total de 907 pacientes con el diagn&#243;stico de TCEL con una edad media de 73&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19 a&#241;os&#44; siendo el 50&#44;2&#37; mujeres&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">El 91&#37; de los pacientes presentaron alg&#250;n factor de riesgo&#44; con un 60&#44;4&#37; en tratamiento antitromb&#243;tico &#40;30&#44;6&#37; antiagregaci&#243;n&#44; 29&#44;8&#37; anticoagulaci&#243;n&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se detallan las caracter&#237;sticas demogr&#225;ficas&#44; los factores de riesgo y la puntuaci&#243;n en la escala de Glasgow de la muestra estudiada&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Se detect&#243; hemorragia cerebral en 97 pacientes &#40;11&#37;&#41; al ingreso y 4 casos &#40;0&#44;4&#37;&#41; entre el ingreso y las primeras 24<span class="elsevierStyleHsp" style=""></span>h&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Del total de los 101 pacientes con hemorragia cerebral&#44; 39&#37; fueron sintom&#225;ticas &#40;38&#37; al ingreso&#44; 1&#37; a las 24<span class="elsevierStyleHsp" style=""></span>h de observaci&#243;n&#41;&#44; siendo la amnesia postraum&#225;tica el s&#237;ntoma cl&#237;nico m&#225;s frecuente&#46; Ning&#250;n paciente present&#243; nueva focalidad neurol&#243;gica diferente a la del ingreso ni precis&#243; intervenci&#243;n neuroquir&#250;rgica &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; De los 4 pacientes &#40;0&#44;4&#37;&#41; con hemorragia cerebral a las 24<span class="elsevierStyleHsp" style=""></span>h&#44; un paciente present&#243; empeoramiento de su cefalea inicial&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">De los 216 pacientes en tratamiento con acenocumarol&#44; con una mediana de INR 2&#44;1 &#40;1-4&#44;9&#41;&#44; el 7&#37; &#40;15 pacientes&#41; sufrieron una hemorragia cerebral inicial&#46; De todos ellos&#44; 8 pacientes presentaron un INR superior a 1&#44;3 que precis&#243; ser revertido&#46; La TC de control a las 24<span class="elsevierStyleHsp" style=""></span>h detect&#243; un caso &#40;0&#44;5&#37;&#41; con una nueva hemorragia que curs&#243; de forma asintom&#225;tica&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">De los 55 pacientes en tratamiento con ACOD&#44; 4 pacientes &#40;7&#44;2&#37;&#41; presentaron una hemorragia inicial y un caso &#40;1&#44;8&#37;&#41; a las 24<span class="elsevierStyleHsp" style=""></span>h&#44; que curs&#243; de forma asintom&#225;tica&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En el total de los 278 pacientes en tratamiento antiagregantes&#44; 33 &#40;12&#37;&#41; presentaron una hemorragia inicial y un caso &#40;0&#44;4&#37;&#41; a las 24<span class="elsevierStyleHsp" style=""></span>h&#46; Ning&#250;n paciente con TC craneal inicial normal desarroll&#243; una hemorragia cerebral a las 24<span class="elsevierStyleHsp" style=""></span>h&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">No detectamos un incremento de riesgo significativo de hemorragia cerebral por el tratamiento antitromb&#243;tico previo en ning&#250;n caso &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; En los siguientes 3 meses de seguimiento&#44; ning&#250;n paciente reingres&#243; por complicaciones neurol&#243;gicas o hemorragia cerebral&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">El estudio de predictores independientes de riesgo de hemorragia en la TC craneal inicial detect&#243; los siguientes factores&#59; edad&#44; el TCEL asociado a politraumatismo&#44; la presencia de fractura craneal&#44; amnesia postraum&#225;tica y v&#243;mitos&#46; No detectamos ning&#250;n predictor de riesgo de hemorragia cerebral a las 24<span class="elsevierStyleHsp" style=""></span>h &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discusi&#243;n</span><p id="par0130" class="elsevierStylePara elsevierViewall">En nuestro estudio los pacientes con TCEL sin lesi&#243;n en la TC craneal al ingreso&#44; no presentaron complicaciones neurol&#243;gicas en los siguientes 3 meses&#44; independientemente del tratamiento antitromb&#243;tico previo&#46; Estos resultados sugieren que los pacientes con TCEL sin lesi&#243;n en la TC craneal no precisar&#237;an periodo de observaci&#243;n ni TC craneal de control tal y como se sugiere en las recomendaciones actuales<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">4&#8211;8&#44;17</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Acorde a estudios previos&#44; nuestra serie mostr&#243; tasas similares tanto de hemorragia inicial &#40;11&#37;&#41; como a las 24<span class="elsevierStyleHsp" style=""></span>h de observaci&#243;n &#40;0&#44;3&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">18&#8211;20</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Las hemorragias cerebrales se presentaron en un 78&#37; con sintomatolog&#237;a leve independientemente del tratamiento antitromb&#243;tico previo&#44; sin detectarse en ning&#250;n caso nueva focalidad neurol&#243;gica o deterioro del nivel de conciencia en las primeras 24<span class="elsevierStyleHsp" style=""></span>h&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La evoluci&#243;n despu&#233;s del alta fue excelente&#44; sin precisar en ning&#250;n caso el reingreso por hemorragia cerebral en los siguientes 3 meses&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Dada la heterogeneidad de los estudios previos y la falta de evidencia cient&#237;fica&#44; actualmente se recomienda que la indicaci&#243;n de observaci&#243;n durante las primeras 24<span class="elsevierStyleHsp" style=""></span>h en el TCEL con alg&#250;n factor de riesgo se realice a criterio cl&#237;nico<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">En nuestra serie&#44; el 91&#37; de pacientes presentaron factores de riesgo y no detectamos deterioro neurol&#243;gico o complicaci&#243;n hemorr&#225;gica grave en ning&#250;n paciente durante las primeras 24<span class="elsevierStyleHsp" style=""></span>h de observaci&#243;n&#44; datos similares a estudios previos<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a>&#46; Nuestro estudio&#44; incluye datos complementarios de seguimiento m&#225;s all&#225; de las primeras 24<span class="elsevierStyleHsp" style=""></span>h&#44; sin detectarse complicaciones en los siguientes 3 meses&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">A diferencia de trabajos previos<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">9&#8211;12</span></a>&#44; nuestra serie incluy&#243; informaci&#243;n sobre la evoluci&#243;n de los pacientes con TCEL tratados con distintos tipos de antiagregantes&#44; anticoagulantes dicumar&#237;nicos as&#237; como con ACOD en poblaci&#243;n adulta sin l&#237;mite de edad<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a>&#44; sin detectarse diferencias significativas en las tasas de hemorragia en funci&#243;n del tipo de tratamiento &#40;acenocumarol 7&#44;4&#37;&#44; apixab&#225;n 10&#37;&#44; rivaroxab&#225;n 0&#37;&#44; dabigatr&#225;n 0&#37;&#44; edoxab&#225;n 0&#37;&#44; AAS 13&#37;&#44; clopidogrel 10&#37;&#44; ticagrelor 0&#37;&#44; no antitromb&#243;ticos 12&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;3&#41;&#44; siendo tasas similares a las encontradas en otras series<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">9&#8211;12</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Respecto a los predictores de hemorragia cerebral descritos en la literatura &#40;edad&#44; tratamiento antitromb&#243;tico&#44; nivel de INR&#44; cefalea&#44; v&#243;mitos o disminuci&#243;n de conciencia&#41;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">12&#44;21</span></a>&#44; en nuestro trabajo no hemos detectado que el tipo de tratamiento antitromb&#243;tico o el nivel de INR se correlacionara con el desarrollo de hemorragia cerebral en el TCEL&#46; Posibles explicaciones para estas diferencias podr&#237;an ser las bajas tasas de hemorragia de los anticoagulantes orales de acci&#243;n directa&#44; la escasa gravedad de nuestra serie comparado con estudios previos<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">18&#8211;20</span></a> o la baja tasa de INR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3 &#40;14&#37;&#41; en nuestra serie<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">9&#8211;12</span></a>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Limitaciones</span><p id="par0170" class="elsevierStylePara elsevierViewall">Nuestro estudio presenta diferentes limitaciones&#58; 1&#41; Estudio realizado en un &#250;nico centro&#44; lo que dificulta la extrapolaci&#243;n de sus resultados&#44; 2&#41; Es un estudio retrospectivo y los resultados podr&#237;an estar sesgados por las limitaciones propias de su metodolog&#237;a&#44; y 3&#41; Solo se realiz&#243; una TC craneal de control a las 24<span class="elsevierStyleHsp" style=""></span>h en aquellos pacientes con deterioro neurol&#243;gico o TC craneal inicial patol&#243;gica&#44; lo que podr&#237;a estar infra estimando la aparici&#243;n de hemorragias cerebrales asintom&#225;ticas en el resto de la muestra&#46; Sin embargo&#44; dada la excelente evoluci&#243;n de los pacientes&#44; dichas hemorragias ser&#237;an de escasa relevancia cl&#237;nica&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusiones</span><p id="par0175" class="elsevierStylePara elsevierViewall">Los resultados de nuestro estudio sugieren que los pacientes con TCEL asintom&#225;ticos&#44; sin lesi&#243;n en la TC craneal &#40;independientemente del tipo de tratamiento antitromb&#243;tico previo o nivel de INR&#41;&#44; podr&#237;an ser dados de alta de urgencias sin periodo de observaci&#243;n&#46; Ser&#237;a recomendable realizar una TC craneal de control a las 24<span class="elsevierStyleHsp" style=""></span>h en aquellos casos con deterioro neurol&#243;gico o TC craneal inicial patol&#243;gica&#46; Futuros estudios prospectivos permitir&#225;n validar nuestros resultados&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Financiaci&#243;n</span><p id="par0180" class="elsevierStylePara elsevierViewall">Los autores declaran que el presente trabajo no ha recibido financiaci&#243;n&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El tiempo de observaci&#243;n en el traumatismo craneoencef&#225;lico leve &#40;TCEL&#41; es controvertido&#46; Nuestro objetivo se bas&#243; en evaluar el riesgo de complicaciones neurol&#243;gicas en el TCEL con y sin tratamiento antitromb&#243;tico&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Evaluamos retrospectivamente los pacientes con TCEL atendidos en urgencias durante 3 a&#241;os&#46; Consideramos TCEL aquellos con Glasgow &#8805;<span class="elsevierStyleHsp" style=""></span>13 al ingreso&#46; Se realiz&#243; una TC craneal en todos los casos con <span class="elsevierStyleUnderline">&#62;</span><span class="elsevierStyleHsp" style=""></span>1 factor de riesgo al ingreso y a las 24<span class="elsevierStyleHsp" style=""></span>h en aquellos con deterioro neurol&#243;gico o TC craneal inicial patol&#243;gica&#46; Se revis&#243; retrospectivamente las complicaciones en los siguientes 3 meses&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Evaluamos 907 pacientes con una edad media de 73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19 a&#241;os&#46; El 91&#37; presentaron factores de riesgo&#44; con un 60&#37; en tratamiento antitromb&#243;tico&#46; Detectamos un 11&#37; de hemorragia cerebral inicial&#44; 0&#44;4&#37; a las 24<span class="elsevierStyleHsp" style=""></span>h y ning&#250;n caso a los 3 meses&#46; El tratamiento antitromb&#243;tico no se asoci&#243; con incremento de riesgo de hemorragia cerebral &#40;9&#44;9 con vs&#46; 11&#44;9&#37; sin tratamiento&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;3&#41;&#46; El 39&#37; de las hemorragias presentaron s&#237;ntomas neurol&#243;gicos &#40;18&#37; amnesia postraum&#225;tica&#44; 12&#37; cefalea&#44; 8&#37; v&#243;mitos&#44; 1&#37; convulsiones&#41;&#44; siendo en un 78&#44;4&#37; s&#237;ntomas leves&#46; De las 4 hemorragias detectadas a las 24<span class="elsevierStyleHsp" style=""></span>h&#44; 3 fueron asintom&#225;ticas y un caso empor&#243; la cefalea inicial&#46; Ning&#250;n paciente asintom&#225;tico sin lesi&#243;n en la TC craneal inicial present&#243; cl&#237;nica a las 24<span class="elsevierStyleHsp" style=""></span>h&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Nuestro estudio sugiere que los pacientes con TCEL asintom&#225;ticos&#44; sin lesi&#243;n en la TC craneal inicial no precisar&#237;an periodo de observaci&#243;n ni TC craneal de control&#44; independientemente del tratamiento antitromb&#243;tico o nivel de INR&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The observation time in mild traumatic brain injury &#40;mTBI&#41; is controversial&#46; Our aim was to assess the risk of neurological complications in mTBI with and without antithrombotic treatment&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We retrospectively evaluated patients with mTBI seen in the emergency room for 3 years&#46; We considered MTBI those with Glasgow &#8805;13 at admission&#46; A cranial CT was performed in all cases with <span class="elsevierStyleUnderline">&#62;</span>1 risk factor at admission and at 24<span class="elsevierStyleHsp" style=""></span>h in those with neurological impairment or initial pathological cranial CT&#46; Complications in the following 3 months were retrospectively reviewed&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We evaluated 907 patients with a mean age of 73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19 years&#46; Ninety-one percent presented risk factors&#44; with 60&#37; on antithrombotic treatment&#46; We detected 11&#37; of initial brain hemorrhage&#44; 0&#46;4&#37; at 24<span class="elsevierStyleHsp" style=""></span>h&#44; and no cases at 3 months&#46; Antithrombotic treatment was not associated with an increased risk of brain hemorrhage &#40;9&#46;9&#37; with vs&#46; 11&#46;9&#37; without treatment&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;3&#41;&#46; 39&#37; of the hemorrhages presented neurological symptoms &#40;18&#37; post-traumatic amnesia&#44; 12&#37; headache&#44; 8&#37; vomiting&#44; 1&#37; seizures&#41;&#44; with 78&#46;4&#37; having mild symptoms&#46; Of the 4 hemorrhages detected at 24<span class="elsevierStyleHsp" style=""></span>h&#44; 3 were asymptomatic and one case that worsened the initial headache&#46; No asymptomatic patient without lesion on initial clinical cranial CT presented at 24<span class="elsevierStyleHsp" style=""></span>h&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Our study suggests that patients with asymptomatic mTBI&#44; without a lesion on the initial cranial CT&#44; would not require the observation period or CT control regardless of antithrombotic treatment or INR level&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Introduction"
          ]
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          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
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          ]
        ]
      ]
    ]
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">73&#44;19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo &#40;mujer&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">455&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Escala de Glasgow &#40;puntuaci&#243;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">874&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">96&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Intoxicaci&#243;n por OH&#47;drogas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Politraumatismo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Amnesia postraum&#225;tica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">102&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">V&#243;mitos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cefalea</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento antitromb&#243;tico</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">549&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">271&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">29&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antiagregaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">278&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HIC al ingresoN<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>97&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HIC 24<span class="elsevierStyleHsp" style=""></span>h de observaci&#243;nN<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HIC entre 24<span class="elsevierStyleHsp" style=""></span>hy 3 meses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Amnesia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "Epidemiology of traumatic brain injury in europe"
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                          "etal" => true
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                            0 => "W&#46; Peeters"
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                            2 => "S&#46; Polinder"
                            3 => "A&#46; Brazinova"
                            4 => "E&#46;W&#46; Steyerberg"
                            5 => "H&#46;F&#46; Lingsma"
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                    0 => array:2 [
                      "doi" => "10.1007/s00701-015-2512-7"
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                        "tituloSerie" => "Acta Neurochir &#40;Wien&#41;"
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                        "volumen" => "157"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26269030"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The incidence of traumatic brain injury in an adult population--how to classify mild cases&#63;"
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                          "etal" => false
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                            0 => "H&#46;J&#46; Numminen"
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                    0 => array:2 [
                      "doi" => "10.1111/j.1468-1331.2010.03179.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Neurol"
                        "fecha" => "2011"
                        "volumen" => "18"
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                        "paginaFinal" => "464"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20722703"
                            "web" => "Medline"
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              "etiqueta" => "3"
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                  "contribucion" => array:1 [
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                      "titulo" => "The canadian ct head rule for patients with minor head injury"
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                          "etal" => true
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                            2 => "K&#46; Vandemheen"
                            3 => "C&#46; Clement"
                            4 => "H&#46; Lesiuk"
                            5 => "A&#46; Laupacis"
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                      "doi" => "10.1016/s0140-6736(00)04561-x"
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                        "paginaFinal" => "1396"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11356436"
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                      "titulo" => "Indications for computed tomography in patients with minor head injury"
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                      "titulo" => "Minor head injury&#58; Guidelines for the use of CT--a multicenter validation study"
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                      "titulo" => "Reliability of clinical guidelines in the detection of patients at risk following mild head injury&#58; Results of a prospective study"
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                            3 => "E&#46; Sanchez"
                            4 => "M&#46;A&#46; Poca"
                            5 => "D&#46; Rodriguez"
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                    0 => array:2 [
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Original
Riesgo de hemorragia cerebral en el traumatismo craneal leve y tratamiento antitrombótico
Risk of cerebral hemorrhage in mild traumatic brain injury and antithrombotic treatment
J.J. Martínez-Rivasa,
Autor para correspondencia
jjmartinez@fphag.org

Autor para correspondencia.
, F. Rodríguez-Lucasa, G. Planellsa, D. Corralesa, D. Cochob,c
a Servicio de Urgencias, Hospital General de Granollers, Granollers, Barcelona, España
b Servicio de Neurología, Hospital General de Granollers, Granollers, Barcelona, España
c Universitat Internacional de Catalunya, Barcelona, España
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craneal en los pacientes con TCEL y al menos un factor de riesgo&#44; con un nivel de evidencia tipo A<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">4&#8211;8</span></a>&#46; Respecto al tiempo de observaci&#243;n tras un TCEL&#44; el nivel de evidencia es menor &#40;nivel C&#41;&#44; recomendando un periodo de observaci&#243;n entre 12 y 24 <span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">h</span> a&#250;n con TC craneal inicial normal<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">9&#8211;12</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Por lo tanto&#44; actualmente no disponemos de suficiente evidencia sobre el tiempo necesario de observaci&#243;n en pacientes con TCEL&#44; as&#237; como la necesidad de repetir una nueva prueba de neuroimagen&#46; La falta de evidencia se hace a&#250;n mayor en los pacientes tratados con anticoagulantes orales de acci&#243;n directa&#44; 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la amnesia post traum&#225;tica&#44; definida como cualquier p&#233;rdida de memoria inmediatamente despu&#233;s del TCE con una duraci&#243;n inferior a 24<span class="elsevierStyleHsp" style=""></span>h<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a>&#44; edad &#62;<span class="elsevierStyleHsp" style=""></span>60 a&#241;os&#44; el consumo de alcohol o drogas de abuso&#44; el uso de f&#225;rmacos antitromb&#243;ticos &#40;antiplaquetarios&#44; anticoagulantes de acci&#243;n directa o dicumar&#237;nicos&#41;&#44; el TCEL en el contexto de un politrauma&#44; la cefalea intensa o persistente&#44; los v&#243;mitos de repetici&#243;n o en escopetazo y las crisis convulsivas<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">5&#44;7&#44;11&#44;14</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Todos los pacientes seleccionados que recibieron tratamiento antiagregante recibieron la misma dosis considerada de mantenimiento para cada f&#225;rmaco&#58; 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el test de Chi-cuadrado o la prueba exacta de Fisher seg&#250;n aplicara&#46; En el caso de las variables continuas se utiliz&#243; la prueba de la t de Student para datos independientes o la prueba de la U de Mann-Whitney dependiendo del tipo de datos&#46; Para evaluar los predictores independientes de hemorragia cerebral&#44; se realiz&#243; un an&#225;lisis multivariado con aquellas variables con una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 en el an&#225;lisis univariado&#46; Para todas las comparaciones se consider&#243; un nivel de significaci&#243;n estad&#237;stica de 0&#44;05 bilateral&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">Se incluyeron un total de 907 pacientes con el diagn&#243;stico de TCEL con una edad media de 73&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19 a&#241;os&#44; siendo el 50&#44;2&#37; mujeres&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">El 91&#37; de los pacientes presentaron alg&#250;n factor de riesgo&#44; con un 60&#44;4&#37; en tratamiento antitromb&#243;tico &#40;30&#44;6&#37; antiagregaci&#243;n&#44; 29&#44;8&#37; anticoagulaci&#243;n&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se detallan las caracter&#237;sticas demogr&#225;ficas&#44; los factores de riesgo y la puntuaci&#243;n en la escala de Glasgow de la muestra estudiada&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Se detect&#243; hemorragia cerebral en 97 pacientes &#40;11&#37;&#41; al ingreso y 4 casos &#40;0&#44;4&#37;&#41; entre el ingreso y las primeras 24<span class="elsevierStyleHsp" style=""></span>h&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Del total de los 101 pacientes con hemorragia cerebral&#44; 39&#37; fueron sintom&#225;ticas &#40;38&#37; al ingreso&#44; 1&#37; a las 24<span class="elsevierStyleHsp" style=""></span>h de observaci&#243;n&#41;&#44; siendo la amnesia postraum&#225;tica el s&#237;ntoma cl&#237;nico m&#225;s frecuente&#46; Ning&#250;n paciente present&#243; nueva focalidad neurol&#243;gica diferente a la del ingreso ni precis&#243; intervenci&#243;n neuroquir&#250;rgica &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; De los 4 pacientes &#40;0&#44;4&#37;&#41; con hemorragia cerebral a las 24<span class="elsevierStyleHsp" style=""></span>h&#44; un paciente present&#243; empeoramiento de su cefalea inicial&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">De los 216 pacientes en tratamiento con acenocumarol&#44; con una mediana de INR 2&#44;1 &#40;1-4&#44;9&#41;&#44; el 7&#37; &#40;15 pacientes&#41; sufrieron una hemorragia cerebral inicial&#46; De todos ellos&#44; 8 pacientes presentaron un INR superior a 1&#44;3 que precis&#243; ser revertido&#46; La TC de control a las 24<span class="elsevierStyleHsp" style=""></span>h detect&#243; un caso &#40;0&#44;5&#37;&#41; con una nueva hemorragia que curs&#243; de forma asintom&#225;tica&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">De los 55 pacientes en tratamiento con ACOD&#44; 4 pacientes &#40;7&#44;2&#37;&#41; presentaron una hemorragia inicial y un caso &#40;1&#44;8&#37;&#41; a las 24<span class="elsevierStyleHsp" style=""></span>h&#44; que curs&#243; de forma asintom&#225;tica&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En el total de los 278 pacientes en tratamiento antiagregantes&#44; 33 &#40;12&#37;&#41; presentaron una hemorragia inicial y un caso &#40;0&#44;4&#37;&#41; a las 24<span class="elsevierStyleHsp" style=""></span>h&#46; Ning&#250;n paciente con TC craneal inicial normal desarroll&#243; una hemorragia cerebral a las 24<span class="elsevierStyleHsp" style=""></span>h&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">No detectamos un incremento de riesgo significativo de hemorragia cerebral por el tratamiento antitromb&#243;tico previo en ning&#250;n caso &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; En los siguientes 3 meses de seguimiento&#44; ning&#250;n paciente reingres&#243; por complicaciones neurol&#243;gicas o hemorragia cerebral&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">El estudio de predictores independientes de riesgo de hemorragia en la TC craneal inicial detect&#243; los siguientes factores&#59; edad&#44; el TCEL asociado a politraumatismo&#44; la presencia de fractura craneal&#44; amnesia postraum&#225;tica y v&#243;mitos&#46; No detectamos ning&#250;n predictor de riesgo de hemorragia cerebral a las 24<span class="elsevierStyleHsp" style=""></span>h &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discusi&#243;n</span><p id="par0130" class="elsevierStylePara elsevierViewall">En nuestro estudio los pacientes con TCEL sin lesi&#243;n en la TC craneal al ingreso&#44; no presentaron complicaciones neurol&#243;gicas en los siguientes 3 meses&#44; independientemente del tratamiento antitromb&#243;tico previo&#46; Estos resultados sugieren que los pacientes con TCEL sin lesi&#243;n en la TC craneal no precisar&#237;an periodo de observaci&#243;n ni TC craneal de control tal y como se sugiere en las recomendaciones actuales<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">4&#8211;8&#44;17</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Acorde a estudios previos&#44; nuestra serie mostr&#243; tasas similares tanto de hemorragia inicial &#40;11&#37;&#41; como a las 24<span class="elsevierStyleHsp" style=""></span>h de observaci&#243;n &#40;0&#44;3&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">18&#8211;20</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Las hemorragias cerebrales se presentaron en un 78&#37; con sintomatolog&#237;a leve independientemente del tratamiento antitromb&#243;tico previo&#44; sin detectarse en ning&#250;n caso nueva focalidad neurol&#243;gica o deterioro del nivel de conciencia en las primeras 24<span class="elsevierStyleHsp" style=""></span>h&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La evoluci&#243;n despu&#233;s del alta fue excelente&#44; sin precisar en ning&#250;n caso el reingreso por hemorragia cerebral en los siguientes 3 meses&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Dada la heterogeneidad de los estudios previos y la falta de evidencia cient&#237;fica&#44; actualmente se recomienda que la indicaci&#243;n de observaci&#243;n durante las primeras 24<span class="elsevierStyleHsp" style=""></span>h en el TCEL con alg&#250;n factor de riesgo se realice a criterio cl&#237;nico<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">En nuestra serie&#44; el 91&#37; de pacientes presentaron factores de riesgo y no detectamos deterioro neurol&#243;gico o complicaci&#243;n hemorr&#225;gica grave en ning&#250;n paciente durante las primeras 24<span class="elsevierStyleHsp" style=""></span>h de observaci&#243;n&#44; datos similares a estudios previos<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a>&#46; Nuestro estudio&#44; incluye datos complementarios de seguimiento m&#225;s all&#225; de las primeras 24<span class="elsevierStyleHsp" style=""></span>h&#44; sin detectarse complicaciones en los siguientes 3 meses&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">A diferencia de trabajos previos<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">9&#8211;12</span></a>&#44; nuestra serie incluy&#243; informaci&#243;n sobre la evoluci&#243;n de los pacientes con TCEL tratados con distintos tipos de antiagregantes&#44; anticoagulantes dicumar&#237;nicos as&#237; como con ACOD en poblaci&#243;n adulta sin l&#237;mite de edad<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a>&#44; sin detectarse diferencias significativas en las tasas de hemorragia en funci&#243;n del tipo de tratamiento &#40;acenocumarol 7&#44;4&#37;&#44; apixab&#225;n 10&#37;&#44; rivaroxab&#225;n 0&#37;&#44; dabigatr&#225;n 0&#37;&#44; edoxab&#225;n 0&#37;&#44; AAS 13&#37;&#44; clopidogrel 10&#37;&#44; ticagrelor 0&#37;&#44; no antitromb&#243;ticos 12&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;3&#41;&#44; siendo tasas similares a las encontradas en otras series<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">9&#8211;12</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Respecto a los predictores de hemorragia cerebral descritos en la literatura &#40;edad&#44; tratamiento antitromb&#243;tico&#44; nivel de INR&#44; cefalea&#44; v&#243;mitos o disminuci&#243;n de conciencia&#41;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">12&#44;21</span></a>&#44; en nuestro trabajo no hemos detectado que el tipo de tratamiento antitromb&#243;tico o el nivel de INR se correlacionara con el desarrollo de hemorragia cerebral en el TCEL&#46; Posibles explicaciones para estas diferencias podr&#237;an ser las bajas tasas de hemorragia de los anticoagulantes orales de acci&#243;n directa&#44; la escasa gravedad de nuestra serie comparado con estudios previos<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">18&#8211;20</span></a> o la baja tasa de INR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3 &#40;14&#37;&#41; en nuestra serie<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">9&#8211;12</span></a>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Limitaciones</span><p id="par0170" class="elsevierStylePara elsevierViewall">Nuestro estudio presenta diferentes limitaciones&#58; 1&#41; Estudio realizado en un &#250;nico centro&#44; lo que dificulta la extrapolaci&#243;n de sus resultados&#44; 2&#41; Es un estudio retrospectivo y los resultados podr&#237;an estar sesgados por las limitaciones propias de su metodolog&#237;a&#44; y 3&#41; Solo se realiz&#243; una TC craneal de control a las 24<span class="elsevierStyleHsp" style=""></span>h en aquellos pacientes con deterioro neurol&#243;gico o TC craneal inicial patol&#243;gica&#44; lo que podr&#237;a estar infra estimando la aparici&#243;n de hemorragias cerebrales asintom&#225;ticas en el resto de la muestra&#46; Sin embargo&#44; dada la excelente evoluci&#243;n de los pacientes&#44; dichas hemorragias ser&#237;an de escasa relevancia cl&#237;nica&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusiones</span><p id="par0175" class="elsevierStylePara elsevierViewall">Los resultados de nuestro estudio sugieren que los pacientes con TCEL asintom&#225;ticos&#44; sin lesi&#243;n en la TC craneal &#40;independientemente del tipo de tratamiento antitromb&#243;tico previo o nivel de INR&#41;&#44; podr&#237;an ser dados de alta de urgencias sin periodo de observaci&#243;n&#46; Ser&#237;a recomendable realizar una TC craneal de control a las 24<span class="elsevierStyleHsp" style=""></span>h en aquellos casos con deterioro neurol&#243;gico o TC craneal inicial patol&#243;gica&#46; Futuros estudios prospectivos permitir&#225;n validar nuestros resultados&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Financiaci&#243;n</span><p id="par0180" class="elsevierStylePara elsevierViewall">Los autores declaran que el presente trabajo no ha recibido financiaci&#243;n&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El tiempo de observaci&#243;n en el traumatismo craneoencef&#225;lico leve &#40;TCEL&#41; es controvertido&#46; Nuestro objetivo se bas&#243; en evaluar el riesgo de complicaciones neurol&#243;gicas en el TCEL con y sin tratamiento antitromb&#243;tico&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Evaluamos retrospectivamente los pacientes con TCEL atendidos en urgencias durante 3 a&#241;os&#46; Consideramos TCEL aquellos con Glasgow &#8805;<span class="elsevierStyleHsp" style=""></span>13 al ingreso&#46; Se realiz&#243; una TC craneal en todos los casos con <span class="elsevierStyleUnderline">&#62;</span><span class="elsevierStyleHsp" style=""></span>1 factor de riesgo al ingreso y a las 24<span class="elsevierStyleHsp" style=""></span>h en aquellos con deterioro neurol&#243;gico o TC craneal inicial patol&#243;gica&#46; Se revis&#243; retrospectivamente las complicaciones en los siguientes 3 meses&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Evaluamos 907 pacientes con una edad media de 73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19 a&#241;os&#46; El 91&#37; presentaron factores de riesgo&#44; con un 60&#37; en tratamiento antitromb&#243;tico&#46; Detectamos un 11&#37; de hemorragia cerebral inicial&#44; 0&#44;4&#37; a las 24<span class="elsevierStyleHsp" style=""></span>h y ning&#250;n caso a los 3 meses&#46; El tratamiento antitromb&#243;tico no se asoci&#243; con incremento de riesgo de hemorragia cerebral &#40;9&#44;9 con vs&#46; 11&#44;9&#37; sin tratamiento&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;3&#41;&#46; El 39&#37; de las hemorragias presentaron s&#237;ntomas neurol&#243;gicos &#40;18&#37; amnesia postraum&#225;tica&#44; 12&#37; cefalea&#44; 8&#37; v&#243;mitos&#44; 1&#37; convulsiones&#41;&#44; siendo en un 78&#44;4&#37; s&#237;ntomas leves&#46; De las 4 hemorragias detectadas a las 24<span class="elsevierStyleHsp" style=""></span>h&#44; 3 fueron asintom&#225;ticas y un caso empor&#243; la cefalea inicial&#46; Ning&#250;n paciente asintom&#225;tico sin lesi&#243;n en la TC craneal inicial present&#243; cl&#237;nica a las 24<span class="elsevierStyleHsp" style=""></span>h&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Nuestro estudio sugiere que los pacientes con TCEL asintom&#225;ticos&#44; sin lesi&#243;n en la TC craneal inicial no precisar&#237;an periodo de observaci&#243;n ni TC craneal de control&#44; independientemente del tratamiento antitromb&#243;tico o nivel de INR&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The observation time in mild traumatic brain injury &#40;mTBI&#41; is controversial&#46; Our aim was to assess the risk of neurological complications in mTBI with and without antithrombotic treatment&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We retrospectively evaluated patients with mTBI seen in the emergency room for 3 years&#46; We considered MTBI those with Glasgow &#8805;13 at admission&#46; A cranial CT was performed in all cases with <span class="elsevierStyleUnderline">&#62;</span>1 risk factor at admission and at 24<span class="elsevierStyleHsp" style=""></span>h in those with neurological impairment or initial pathological cranial CT&#46; Complications in the following 3 months were retrospectively reviewed&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We evaluated 907 patients with a mean age of 73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19 years&#46; Ninety-one percent presented risk factors&#44; with 60&#37; on antithrombotic treatment&#46; We detected 11&#37; of initial brain hemorrhage&#44; 0&#46;4&#37; at 24<span class="elsevierStyleHsp" style=""></span>h&#44; and no cases at 3 months&#46; Antithrombotic treatment was not associated with an increased risk of brain hemorrhage &#40;9&#46;9&#37; with vs&#46; 11&#46;9&#37; without treatment&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;3&#41;&#46; 39&#37; of the hemorrhages presented neurological symptoms &#40;18&#37; post-traumatic amnesia&#44; 12&#37; headache&#44; 8&#37; vomiting&#44; 1&#37; seizures&#41;&#44; with 78&#46;4&#37; having mild symptoms&#46; Of the 4 hemorrhages detected at 24<span class="elsevierStyleHsp" style=""></span>h&#44; 3 were asymptomatic and one case that worsened the initial headache&#46; No asymptomatic patient without lesion on initial clinical cranial CT presented at 24<span class="elsevierStyleHsp" style=""></span>h&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Our study suggests that patients with asymptomatic mTBI&#44; without a lesion on the initial cranial CT&#44; would not require the observation period or CT control regardless of antithrombotic treatment or INR level&#46;</p></span>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">No tratamiento &#40;N</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">358&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;0&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                            2 => "S&#46; Polinder"
                            3 => "A&#46; Brazinova"
                            4 => "E&#46;W&#46; Steyerberg"
                            5 => "H&#46;F&#46; Lingsma"
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                    0 => array:2 [
                      "titulo" => "The incidence of traumatic brain injury in an adult population--how to classify mild cases&#63;"
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ISSN: 00142565
Idioma original: Español
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