Acute haemorrhage rate in 28,000 Out-of-Hours CT heads

Area of Science:

• Neuroradiology
• Emergency Medicine
• Pharmacology

Background:

• CT head imaging demand has significantly increased over 12 years, particularly for out-of-hours investigations.
• Intracranial hemorrhage (ICH) rates have remained stable in recent years, justifying the rise in imaging.
• Anticoagulant use, including warfarin and direct oral anticoagulants (DOACs), is common in patients undergoing CT head scans.

Purpose of the Study:

• To assess the acute hemorrhage rate in patients undergoing CT head investigations.
• To compare hemorrhage rates between patients with and without trauma.
• To compare hemorrhage rates between patients on warfarin and DOACs.

Main Methods:

• Retrospective analysis of CT head scans performed between 2008 and 2019 at Sheffield Teaching Hospitals.
• Identification of scans with available requesting information from 2015 onwards.
• Clinical information assessed for trauma or anticoagulation; reports categorized into acute and non-acute findings.

Main Results:

• CT head scans increased by 63% from 2008-2019, with out-of-hours scans rising by 278%.
• Acute ICH incidence averaged 6.9% between 2015-2019.
• Hemorrhage detection was lower in anticoagulated patients: warfarin (5.2%) and DOACs (2.8%) compared to non-anticoagulated (6.8%).

Conclusions:

• Despite increased CT head demand, ICH rates are stable, validating the need for imaging.
• Patients prescribed DOACs exhibit a lower incidence of ICH compared to warfarin users and the general population.
• Findings suggest a need to discuss DOAC bleeding risks in relation to CT head imaging guidelines.