Abstract. Objective: To determine the incidence of clinically significant intracranial injury in the anticoagulated patient suffering minor head trauma without loss of consciousness (LOC) or acute neurologic abnormality. Methods: A retrospective chart review was performed based on a computerized search of electronic patient records from six community hospital EDs, one of which is a trauma center. Patients taking warfarin who sustained minor head trauma without LOC having no acute neurologic abnormalities treated from January 1994 to January 1996 were identified using a search of electronic ED records. Charts were reviewed for mechanism of injury, physical examination findings of head injury, and concomitant injury. Prothrombin time and head CT results were recorded if obtained. For those patients not receiving a head CT on ED evaluation, telephone follow-up was performed to determine outcome. Results: There were 65 patients meeting inclusion criteria. Thirty-eight patients had prothrombin times obtained, with ranges from 12.0 sec to 30.7 sec. There was no intracranial injury found in any of the 39 patients having a head CT. Additionally, follow-up on the 26 patients who did not undergo CT scanning revealed no evidence of complications related to their head injuries. Conclusions: The incidence of clinically significant intracranial injury is extremely low in the anticoagulated patient suffering minor blunt head trauma without LOC or acute neurologic abnormality. CT scanning may not be necessary in these patients. Larger prospective studies are needed to confirm these findings. Key words: intracranial injury; anticoagulation; minor head trauma. ACA-DEMIC EMERGENCY MEDICINE 1999; 6:121 -124 E VALUATION of the head-injured patient has been long debated.1 -13 While it is clear that all patients who present with signs of neurologic compromise should undergo immediate CT of the head, argument exists over evaluation of the patient with a Glasgow Coma Score (GCS) of 15 and a normal neurologic examination. Several studies suggest the use of CT for all patients sustaining minor head trauma with a brief period of loss of consciousness (LOC), arguing that as many as 3% of patients who are able to talk after a head injury will deteriorate. 1 -5,7 -9,11,12 However, in the absence of LOC and with a normal neurologic examination in the ED, several authors have concluded that CT scanning is unnecessary and such patients may be safely discharged to home. 4,11,13 To our knowledge, there is no literature referring to the evaluation of the anticoagulated patient taking warfarin who suffers minor head trauma. Retrospective studies of hemophiliacs sustaining minor head trauma without LOC and having a normal neurologic examination have demonstrated that CT scanning of the head is unremarkable. 14 -16 We sought to determine the incidence of intracra- METHODSStudy Design. This was a retrospective review of the ED records of anticoagulated patients with minor head injury, presenting from January 1, 1994, to December 31, 1995. Follo...
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