Scan ‘Em All – Anticoagulated Minor Head Trauma

September 4, 2018

Written by Clay Smith

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Incidence of intracerebral hemorrhage (ICH) on CT following minor head trauma in anticoagulated patients was 9%, which means we have to CT all these people.

Why does this matter?
Guidelines recommend CT for anticoagulated patients who have minor head trauma, including NICE and the CDC.  Do we really need to do that?  Yup…we do.

Scan ’em all
They started with over 10,000 studies and whittled it down to just 5 that met criteria.  Almost all had low risk of bias.  In this meta-analysis of these 5 prospective studies with 4080 anticoagulated patients with head injury and GCS 15, the incidence of initial or delayed ICH on CT was 9%.  When the study with greater risk of bias was removed from the analysis, incidence of ICH was 11%.  Of these, 98% were taking warfarin.  The newer direct oral anticoagulants and LMWH were not well represented.  The implication of this is that patients who are anticoagulated need a head CT even if they look well and have normal GCS.  Incidence of intracranial findings is too high to safely avoid it.

Source
Incidence of intracranial bleeding in anticoagulated patients with minor head injury: a systematic review and meta-analysis of prospective studies.  Br J Haematol. 2018 Jul 20. doi: 10.1111/bjh.15509. [Epub ahead of print]
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Another Spoonful
EM Lit of Note came to a similar conclusion.

Reviewed by Thomas Davis