The prevalence of clinically relevant delayed intracranial hemorrhage in head trauma patients treated with oral...

Area of Science:

• Emergency Medicine
• Neurosurgery
• Radiology

Background:

• Current Scandinavian guidelines recommend 24-hour observation for head trauma patients on anticoagulants.
• This observation period is intended to detect delayed intracranial hemorrhages, even after a normal initial head CT scan.
• The study investigates the actual incidence and timing of clinically relevant delayed intracranial hemorrhages in this patient group.

Purpose of the Study:

• To assess the prevalence of clinically relevant delayed intracranial hemorrhage in head trauma patients on oral anticoagulants.
• To determine the time to diagnosis for these delayed hemorrhages.
• To evaluate the current 24-hour observation guideline's effectiveness.

Main Methods:

• Retrospective cohort study using two-year data from Region Skåne's emergency departments.
• Included adult head trauma patients prescribed oral anticoagulants.
• Defined delayed intracranial hemorrhage as bleeding not visible on initial CT head scan, and clinically relevant if associated with mortality, ICU admission, or neurosurgery.

Main Results:

• Out of 2,362 head injury cases, five patients developed delayed intracranial hemorrhages.
• Only two cases (0.08%) were clinically relevant, involving subdural hematomas in elderly patients who died.
• Diagnosis occurred 4 and 7 days post-initial presentation; no neurosurgery or ICU admission was required for these delayed hemorrhages.

Conclusions:

• The incidence of clinically relevant delayed intracranial hemorrhage in head trauma patients on oral anticoagulation is very low (<0.1%).
• Detection of these hemorrhages frequently occurs more than 24 hours after presentation.
• The findings suggest a need to re-evaluate the Scandinavian Neurotrauma Committee's 24-hour observation guideline for optimized patient care and resource allocation.