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The role of delayed head CT in evaluation of elderly blunt head trauma victims taking antithrombotic therapy

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

Increasing active longevity has created an increasing surge of elderly trauma patients. The majority of these patients suffer blunt trauma and many are taking antithrombotic agents. The literature is mixed regarding the utility of routine repeat head CT in patients taking antithrombotic medications with a GCS of 15 and initial negative head CT. We hypothesized that scheduled delayed CT head 12 h after admission (D-CTH) in elderly blunt trauma victims would not identify clinically significant new hemorrhages or change management.

Methods

A retrospective chart review using our institutional trauma registry of patients ≥65 years sustaining blunt head injuries from 2010 to 2012 was performed. By hospital protocol, all such patients on antithrombotic therapy receive a routine D-CTH. All of these patients were included. Demographics, injuries, medications, laboratory values, LOS, mental status, and management were analyzed.

Results

Of the 234 patients meeting inclusion criteria, 8 initially were identified as having D-ICH. Upon further review, five patients had the same findings on both initial and delayed CT scans and one patient was determined to actually have had a hemorrhage stroke. Ultimately, only two patients (0.85%, 95% CI 0.1–3.1%) had new ICH discovered on D-CTH. None of the patients on warfarin demonstrated any new injury on D-CTH (95% CI ≤ 4.6%). Only one patient taking aspirin as a sole agent had a delayed injury on D-CTH (1.1%, 95% CI 0–4.2%). The remaining patient was taking a combination of aspirin and clopidogrel representing 2.2% of 45 patients on combination therapy (95% CI 0.1–11.8%). Only two patients taking a direct thrombin inhibitor (dabigatran) met inclusion criteria and neither endured a bleed (95% CI ≤ 77.6%). Further analysis revealed no cases with clinical changes or surgical intervention for new ICH on delayed imaging. No inference could be made to predict which patients would suffer D-ICH.

Conclusions

D-CTH in elderly trauma patients taking antithrombotic agents shows no statistically significant or clinical benefit for diagnosing delayed intracranial hemorrhage after minor head injury. In those with delayed imaging showing new ICH, management was not significantly altered. Not enough data were available to predict which patients would develop D-ICH, even if asymptomatic.

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Author notes

  1. D. Scantling and C. Fischer have contributed in the capacity of first author.

Authors and Affiliations

  1. Hahnemann University Hospital, Drexel University College of Medicine, 215 N 15th St MS 413, Philadelphia, PA, 19102, USA

    D. Scantling, C. Fischer, R. Gruner, A. Teichman & B. McCracken

  2. AtlantiCare Regional Medical Center, 1925 Pacific Avenue, Atlantic City, NJ, 08401, USA

    J. Eakins

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  1. D. Scantling
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  2. C. Fischer
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  3. R. Gruner
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  4. A. Teichman
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  5. B. McCracken
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Corresponding author

Correspondence to D. Scantling.

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Conflict of interest

There are no conflicts of interest to disclose for Dane Scantling, Chelsea Fischer, Ryan Gruner, Amanda Teichman, Brendan McCracken, and James Eakins.

Research involving human participants and/or animals

This research involved was conducted in compliance with all international ethical standards and was approved by our institutional review board. All ethical standards were met. This study did not involve experimental intervention and there was no mechanism to cause harm to patients.

Informed consent

This study was retrospective in nature. Our institutional review board determined that consent was not necessary and all identities were fully protected.

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Scantling, D., Fischer, C., Gruner, R. et al. The role of delayed head CT in evaluation of elderly blunt head trauma victims taking antithrombotic therapy. Eur J Trauma Emerg Surg 43, 741–746 (2017). https://doi.org/10.1007/s00068-017-0793-7

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  • DOI: https://doi.org/10.1007/s00068-017-0793-7

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