Delayed Intracranial Hemorrhage
Dr. Arianne Wenk
One of the very common occurrences in the Emergency Department are falls and of course the majority of those who fall are elderly and on a blood thinner or some combination of blood thinners.
I chose this paper because I wanted to know how common it is for patients in these circumstances to have an initially negative CT head and go on to develop a delayed intracranial hemorrhage.
Delayed intracranial hemorrhage in the patient with blunt trauma on anticoagulant or antiplatelet agents: routine repeat head computed tomography is unnecessary
Hill JH, Bonner P, O'Mara MS, Wood T, Lieber M. Delayed intracranial hemorrhage in the patient with blunt trauma on anticoagulant or antiplatelet agents: routine repeat head computed tomography is unnecessary. Brain Inj. 2018;32(6):735-738. doi: 10.1080/02699052.2018.1441442. Epub 2018 Feb 27. PMID: 29485294.
A retrospective, observational study performed from 2008 to 2012
Repeat head CT is unnecessary- incidence of delayed intracranial hemorrhage is very low and when it occurs it is clinically irrelevant. It may, however, be worthwhile to consider a repeat scan in those with a severe mechanism of injury (which is admittedly subjective) or obvious head trauma.
In conclusion, a period of observation is reasonable but repeat head CT is costly and an unnecessary exposure to radiation.