| Management of minor head injury in patients receiving oral anticoagulant therapy: a prospective study of a 24-hour observation protocol. | |
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MedLine Citation:
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PMID: 22244878 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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STUDY OBJECTIVE: Patients receiving warfarin who experience minor head injury are at risk of intracranial hemorrhage, and optimal management after a single head computed tomography (CT) scan is unclear. We evaluate a protocol of 24-hour observation followed by a second head CT scan. METHODS: In this prospective case series, we enrolled consecutive patients receiving warfarin and showing no intracranial lesions on a first CT scan after minor head injury treated at a Level II trauma center. We implemented a structured clinical pathway, including 24-hour observation and a CT scan performed before discharge. We then evaluated the frequency of death, admission, neurosurgery, and delayed intracranial hemorrhage. RESULTS: We enrolled and observed 97 consecutive patients. Ten refused the second CT scan and were well during 30-day follow-up. Repeated CT scanning in the remaining 87 patients revealed a new hemorrhage lesion in 5 (6%), with 3 subsequently hospitalized and 1 receiving craniotomy. Two patients discharged after completing the study protocol with 2 negative CT scan results were admitted 2 and 8 days later with symptomatic subdural hematomas; neither received surgery. Two of the 5 patients with delayed bleeding at 24 hours had an initial international normalized ratio greater than 3.0, as did both patients with delayed bleeding beyond 24 hours. The relative risk of delayed hemorrhage with an initial international normalized ratio greater than 3.0 was 14 (95% confidence interval 4 to 49). CONCLUSION: For patients receiving warfarin who experience minor head injury and have a negative initial head CT scan result, a protocol of 24-hour observation followed by a second CT scan will identify most occurrences of delayed bleeding. An initial international normalized ratio greater than 3 suggests higher risk. |
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Authors:
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Vincenzo G Menditto; Moira Lucci; Stefano Polonara; Giovanni Pomponio; Armando Gabrielli |
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Publication Detail:
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Type: Journal Article Date: 2012-01-14 |
Journal Detail:
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Title: Annals of emergency medicine Volume: 59 ISSN: 1097-6760 ISO Abbreviation: Ann Emerg Med Publication Date: 2012 Jun |
Date Detail:
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Created Date: 2012-05-25 Completed Date: 2012-08-09 Revised Date: 2013-05-01 |
Medline Journal Info:
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Nlm Unique ID: 8002646 Medline TA: Ann Emerg Med Country: United States |
Other Details:
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Languages: eng Pagination: 451-5 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Emergency Department, Ospedali Riuniti di Ancona, Ancona, Italy. vincenzomenditto74@yahoo.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Anticoagulants / adverse effects* Craniocerebral Trauma / complications, radiography, therapy* Critical Pathways Female Humans Intracranial Hemorrhages / etiology, radiography Male Middle Aged Prospective Studies Time Factors Tomography, X-Ray Computed Trauma Centers Warfarin / adverse effects* Watchful Waiting |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 81-81-2/Warfarin |
| Comments/Corrections | |
Comment In:
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Ann Emerg Med. 2013 Apr;61(4):500-1
[PMID:
23522815
]
Ann Emerg Med. 2013 Apr;61(4):501-2 [PMID: 23522816 ] Ann Emerg Med. 2012 Jun;59(6):457-9 [PMID: 22306486 ] Ann Emerg Med. 2012 Oct;60(4):537-8; author reply 538 [PMID: 23010186 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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