Delayed intracranial hemorrhage in elderly anticoagulated patients sustaining a minor fall

Area of Science:

• Geriatric Trauma
• Neuroimaging
• Emergency Medicine

Background:

• Falls are a leading cause of injury in the elderly.
• Evidence-based guidelines for imaging delayed intracranial hemorrhage (DICH) are lacking.
• Elderly patients on anticoagulant or antiplatelet (ACAP) therapy are at increased risk.

Purpose of the Study:

• To determine the incidence of DICH in elderly patients (≥65 years) on ACAP therapy after a minor fall.
• To evaluate the utility of routine head CT scans in this population.

Main Methods:

• Retrospective review of a Level 1 Trauma Center trauma registry.
• Analysis of 1076 elderly trauma patients, focusing on 838 with minor falls and 513 on pre-injury ACAP medications.
• Calculation of DICH incidence based on head CT findings.

Main Results:

• Only one patient (0.46%) out of 218 who received a repeat head CT had DICH.
• Aspirin and warfarin were the most common ACAP medications.
• 19.27% of patients were on multiple ACAP medications.

Conclusions:

• Universal screening head CT protocols for elderly patients on ACAP after minor falls are expensive and increase radiation exposure.
• An effective risk assessment tool is needed to reduce unnecessary screenings.
• Identifying patients at high risk for DICH is crucial for resource optimization.