How Rare Is Too Rare Not to Care?

Delayed intracranial hemorrhage (ICH) is the most feared complication of blunt head trauma in anticoagulated elderly patients. Current guidelines recommend cranial computed tomography (CT) for patients who have sustained blunt head trauma.¹ Other recommendations suggest that patients receiving any anticoagulation and/or antiplatelet therapy be observed for a minimum of 24 hours and have a repeated head CT scan, even after initial normal CT findings.² Studies have reported rates of delayed ICH in this patient population between 0.1% and 7%.³ In this issue of JAMA Surgery, Chenoweth et al⁴ demonstrate that 1 of 343 patients (0.3%) receiving anticoagulation and/or antiplatelet therapy developed delayed ICH and therefore conclude that repeated imaging and observation may not be necessary.