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Observational Study
. 2018 Jun 1;153(6):570-575.
doi: 10.1001/jamasurg.2017.6159.

Incidence of Delayed Intracranial Hemorrhage in Older Patients After Blunt Head Trauma

James A Chenoweth  1 , Samuel D Gaona  1 , Mark Faul  2 , James F Holmes  1 , Daniel K Nishijima  1 ; Sacramento County Prehospital Research Consortium
Affiliations
Observational Study

Incidence of Delayed Intracranial Hemorrhage in Older Patients After Blunt Head Trauma

James A Chenoweth et al. JAMA Surg. .

Abstract

Importance: Current guidelines conflict on the management of older adults who have blunt head trauma taking anticoagulant and antiplatelet medications. This is partially due to the limited data comparing patients who are taking these medications with those who are not.

Objective: To investigate the incidence of delayed traumatic intracranial hemorrhage in older adults with head trauma, including those taking anticoagulant and antiplatelet medications.

Design, setting, and participants: This prospective observational cohort study included patients 55 years and older who had blunt head trauma and were transported via emergency medical services between August 1, 2015, and September 30, 2016. The setting was a multicenter study conducted at 11 hospitals in northern California. Patients were excluded if they had traumatic intracranial hemorrhage on the initial cranial computed tomographic scan, did not have a cranial computed tomographic scan performed at the initial emergency department visit, refused consent for a follow-up telephone call, or did not have reliable means of follow-up.

Main outcome and measure: The primary outcome of this study was the incidence of delayed traumatic intracranial hemorrhage within 14 days of injury.

Results: Among 859 patients enrolled in the study, the median age was 75 years (interquartile range, 64-85 years), and 389 (45.3%) were male. A total of 343 patients (39.9%) were taking an anticoagulant or antiplatelet medication. Three patients (0.3%; 95% CI, 0.1%-1.0%) had a delayed traumatic intracranial hemorrhage. Of the 3 patients, 1 of 75 patients (1.3%; 95% CI, 0.0%-7.2%) who were taking warfarin sodium alone and 2 of 516 patients (0.4%; 95% CI, 0.1%-1.4%) who were not taking any anticoagulant or antiplatelet medication had a delayed traumatic intracranial hemorrhage. Thirty-nine patients (4.5%; 95% CI, 3.2%-6.2%) were lost to follow-up.

Conclusions and relevance: Overall, the incidence of delayed intracranial hemorrhage in older adults who have blunt head trauma is low, including patients taking an anticoagulant or antiplatelet medication. These findings suggest that routine observation and serial cranial computed tomography may not be necessary in these patients.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.
Figure.. Patient Flow Diagram
CT indicates computed tomographic; ED, emergency department; and ICH, intracranial hemorrhage.
See this image and copyright information in PMC

Comment in

  • How Rare Is Too Rare Not to Care?
    Florecki KL, Haut ER. Florecki KL, et al. JAMA Surg. 2018 Jun 1;153(6):575-576. doi: 10.1001/jamasurg.2017.6155. JAMA Surg. 2018. PMID: 29450460 No abstract available.

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