OC 71.1 - Outcomes of Head Injury in patients with Hemophilia.

Background: Intracranial hemorrhage (ICH) is a leading cause of mortality in Hemophilia patients. There are no specific recommendations for obtaining imaging studies in this patient population.

Aims: To review the clinical variables associated with ICH in Hemophilia patients that sustained a head injury.

Methods: We used a large de-identified health research network with data sourced from 82 health care organizations, within the United States (TriNetX). We identified patients with Hemophilia A or B, and head injury (IDC-10: S09, S06). Patients were categorized into two cohorts, based on head CT/MRI scan performed during the encounter. We performed 1:1 propensity score matching to balance cohorts on age, sex, race, ethnicity, and symptoms at presentation. Baseline differences were calculated using independent t-test and chi-square test or fisher’s exact test. Estimates of odds ratios (OR), and 95% confidence intervals (CI) were used to describe the outcome risks.

Results: Of 24,738 patients with Hemophilia in the database, 2219 patients (9.0%) presented to the ED with head trauma. 1127 (50.8%) with head trauma had a scan during the ED encounter. White patients (73.5 v/s 57.6%; P< 0.001) and patients presenting with ‘Somnolence/stupor/coma’ (6.4 v/s 1.7%; p< 0.001) or Syncope (7 v/s 2.4%; p< 0.001) were more associated with a scan. A diagnosis of ICH was found in 143 (12.3 %) patients and was most commonly seen in scan patients presenting with somnolence (29.7%). Patients with a scan were more likely to be hospitalized (11.9 v/s 7.9%, OR 1.58, p=0.009), admitted to the ICU (6.1 v/s 2%; OR 3.2, p< 0.001), and to receive factor products/plasma (23.3 v/s 18.2%; OR 1.36, p=0.016).

Conclusion(s): In our large nationwide sample, ICH remains a significant morbidity in hemophilia. Better methods are needed for identifying the need of a scan after head trauma in patients with hemophilia