Is it Time to Ditch the DICH (Delayed Intracranial Hemorrhage) Yet?

Area of Science:

• Neurology
• Radiology
• Emergency Medicine

Background:

• Delayed intracranial hemorrhage (DICH) is a rare but recognized complication following head trauma in patients using antiplatelet or anticoagulant medications.
• The incidence and necessity of repeat imaging for this patient group remain areas of clinical uncertainty.

Purpose of the Study:

• To investigate the hypothesis that DICH is unlikely to occur in patients on anticoagulants/antiplatelets without a history of head impact and visible signs of head/face trauma.
• To evaluate the incidence of DICH in patients with head trauma while on anticoagulant/antiplatelet therapy.

Main Methods:

• A two-year retrospective study (2020-2021) analyzed patients with head trauma on antiplatelet/anticoagulant therapy.
• Data collected included initial head CT findings, need for observation, and repeat head CT results.
• The study assessed the association between DICH and clinical signs of trauma.

Main Results:

• Out of 259 patients with head impact on anticoagulants/antiplatelets, 225 (86.9%) had negative initial head CTs.
• Repeat head CTs were performed on 217 patients (96.4%), revealing only one case (0.46%) of DICH.
• The single patient with DICH did not require neurosurgical intervention.

Conclusions:

• DICH is unlikely to develop in patients on anticoagulants/antiplatelets after head trauma, especially without neurological changes.
• Routine repeat head CT scans may be unnecessary, potentially reducing hospital length of stay and healthcare costs.
• Enhanced training is needed for managing patients with head trauma on these medications.