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Abstract

Introduction: Delayed intracranial hemorrhage (DICH) is a recognized complication of blunt head trauma in anticoagulated patients even after initially negative head CT. The reported incidence and complication rate of delayed ICH is inconsistent in existing literature. Routine repeat head CT at 24–48 hours after admission is standard practice in many institutions. We postulate that in the anticoagulated blunt trauma patient, the incidence and complication rate of delayed ICH after an initially negative head CT is low and that routine repeat head CT is not warranted. Methods: The aim of this retrospective, observational study was to determine if a routine repeat CT scan is necessary for patients to identify new, DICH. Data were collected from 338 trauma patients with pre-admission history of any anticoagulant use (including low dose ASA), who had an initially negative head CT, followed by a repeat CT within 12–24 hours. Results: Our sample were 57.7% male, had a mean age of 69.3 (SD14.47). Nearly 55% of the sample had obvious head trauma by observation, 27.2% reported LOC, with an average GCS of 14.5 (SD1.97). DICH was identified in 2.4% (n=8) of the sample on follow-up head CT. All eight patients were taking ASA. Of the eight patients with DICH: 3 were on ASA only, 4 on ASA and Plavix, and 1 on ASA and Coumadin. None of the patients with ICH on repeat CT scan required any surgical intervention. Conclusions: The incidence of delayed ICH in our population was only 2.4% (8/338). Of these 8, none required clinical intervention and there were no mortalities. We identified no significant predictors of delayed ICH, but all were taking ASA either alone or in combination with another anticoagulant. This data suggests that, while a period of clinical follow up is advised, routine repeat head CT is unnecessary in patients who have an initially negative head CT even in the presence of chronic anticoagulant use. This study demonstrates similar incidence of delayed ICH to other studies but includes all forms and doses of anticoagulation.