A Second Look: The Case for Delayed Head Computed Tomography in Older Adult Blunt Trauma Patients on Antithrombotics

Anticoagulant and/or antiplatelet (AC/AP) therapy may confer an added risk of intracranial hemorrhage (ICH) following trauma, but there is some controversy on whether older adult blunt trauma patients on AC/AP require repeat head computed tomography (CT).

A retrospective query of the trauma registry of an ACS-verified Level 1 Adult Trauma Center was performed for older adult (65+) blunt trauma hospitalizations from 2022 to 2023 with ICH. Patients were divided by detection of ICH on index or delayed CT. In those with ICH noted only on delayed CT report (delayed identification of ICH), CT images were reviewed by trauma and neuroradiology faculty to determine whether ICH was retrospectively visible on index CT.

The two groups (350 with ICH on index and 32 on delayed CT) did not differ in presenting demographics. Twenty-six patients with ICH on delayed CT were on AC/APs, two required neurosurgical intervention, and one expired. All 32 had changes in management: admission, upgrade to higher level of care, anti-epileptic administration, and/or AC/AP therapy discontinuation. Five initial CT scans were recategorized as having ICH during hospitalization. Following neuroradiology faculty re-review, 17 had ICH detectable on index CT imaging, 14 had de novo ICH, and one did not have ICH on either study.

Thirty-two (8.4%) patients with ICH were identified only following delayed head CT, with 14 being de novo ICH. Since the majority of patients with delayed identification of ICH were on preadmission AC/AP, and management changed in all, AC/AP utilization appears to be an important risk factor for delayed identification of traumatic ICH.