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Author Spotlight: Deciphering Coagulation Disorders in Traumatic Brain Injury Patients
Published on: August 4, 2023
895
Routine Repeat Imaging Is Unnecessary for Coagulopathic Patients Sustaining Head Trauma
Steadman Wang1, Mitchell Meagher1, Emma Mullin2
1Department of Surgery, Arnot Health Medical Center, Elmira, NY, USA.
The American Surgeon
|March 26, 2022
Summary
Delayed intracranial hemorrhage (ICH) is rare in trauma patients on warfarin without initial ICH. Routine 24-hour repeat CT scans are unlikely to alter management for stable patients, suggesting initial imaging may suffice.
Area of Science:
- Trauma Surgery
- Neurosurgery
- Emergency Medicine
Background:
- Current guidelines mandate CT scans, observation, and repeat CT scans for warfarin patients with trauma.
- This practice persists despite evidence of rare delayed hemorrhage, even in mild traumatic brain injury without initial intracranial hemorrhage (ICH).
Purpose of the Study:
- To determine the incidence and outcomes of delayed intracranial hemorrhage (DICH) in trauma patients on supra-therapeutic warfarin without initial ICH.
Main Methods:
- Retrospective study of adult trauma patients on warfarin with INR >3 and no initial ICH on CT.
- Subsequent CT scans within 24 hours identified DICH; risk factors and outcomes were analyzed.
Main Results:
- Only 3 of 225 patients (1.33%) developed DICH.
- No statistically significant risk factors were identified due to low incidence.
- None of the patients with DICH required intervention.
Conclusions:
- Initial CT scan without ICH is adequate for trauma patients on supra-therapeutic warfarin.
- DICH is uncommon, and routine 24-hour reimaging is unlikely to change management in neurologically stable patients.
