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Original Investigation
June 2018

Incidence of Delayed Intracranial Hemorrhage in Older Patients After Blunt Head Trauma

Author Affiliations
  • 1Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento
  • 2Centers for Disease Control and Prevention, Atlanta, Georgia
JAMA Surg. 2018;153(6):570-575. doi:10.1001/jamasurg.2017.6159
Key Points

Question  What is the incidence of delayed intracranial hemorrhage in patients 55 years and older with blunt head trauma?

Findings  In this multicenter study of 859 adults 55 years and older with blunt head trauma, 3 patients had a delayed intracranial hemorrhage. Of the 3 patients, 1 of 75 was taking warfarin sodium before injury, and 2 of 516 were not taking any anticoagulant or antiplatelet medication.

Meaning  The risk of delayed traumatic intracranial hemorrhage is low even in patients taking anticoagulant or antiplatelet medications.

Abstract

Importance  Current guidelines conflict on the management of older adults who have blunt head trauma taking anticoagulant and antiplatelet medications. This is partially due to the limited data comparing patients who are taking these medications with those who are not.

Objective  To investigate the incidence of delayed traumatic intracranial hemorrhage in older adults with head trauma, including those taking anticoagulant and antiplatelet medications.

Design, Setting, and Participants  This prospective observational cohort study included patients 55 years and older who had blunt head trauma and were transported via emergency medical services between August 1, 2015, and September 30, 2016. The setting was a multicenter study conducted at 11 hospitals in northern California. Patients were excluded if they had traumatic intracranial hemorrhage on the initial cranial computed tomographic scan, did not have a cranial computed tomographic scan performed at the initial emergency department visit, refused consent for a follow-up telephone call, or did not have reliable means of follow-up.

Main Outcome and Measure  The primary outcome of this study was the incidence of delayed traumatic intracranial hemorrhage within 14 days of injury.

Results  Among 859 patients enrolled in the study, the median age was 75 years (interquartile range, 64-85 years), and 389 (45.3%) were male. A total of 343 patients (39.9%) were taking an anticoagulant or antiplatelet medication. Three patients (0.3%; 95% CI, 0.1%-1.0%) had a delayed traumatic intracranial hemorrhage. Of the 3 patients, 1 of 75 patients (1.3%; 95% CI, 0.0%-7.2%) who were taking warfarin sodium alone and 2 of 516 patients (0.4%; 95% CI, 0.1%-1.4%) who were not taking any anticoagulant or antiplatelet medication had a delayed traumatic intracranial hemorrhage. Thirty-nine patients (4.5%; 95% CI, 3.2%-6.2%) were lost to follow-up.

Conclusions and Relevance  Overall, the incidence of delayed intracranial hemorrhage in older adults who have blunt head trauma is low, including patients taking an anticoagulant or antiplatelet medication. These findings suggest that routine observation and serial cranial computed tomography may not be necessary in these patients.

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