D. Scantling1, R. Gruner1, R. Kucejko1, S. Reid1, B. McCracken1 1Hahnemann University Hospital,Surgery,Philadelphia, PA, USA
Introduction:
Increases in active lifespan have created a new generation of elderly trauma patients. The majority of these
patients suffer blunt trauma and many are anticoagulated. The literature regarding routine use of repeat
head CT in elderly patients with an initial ICH on CT is varied when no clinical change has occurred. We
hypothesized that routine delayed CT-head (D-CTH) in elderly blunt trauma victims would not change clinical
management.
Methods:
A retrospective chart review using our institutional trauma registry of patients ≥65 years sustaining blunt
head injuries from 2010-2012 was performed. Patients on anticoagulation who had an ICH present on initial
CT who received routine D-CTH were included. Of 268 anticoagulated elderly patients admitted for blunt
head injury, 25 met inclusion criteria. 9 patients were excluded for clinical deterioration before second CTH.
Demographics, injuries, medications, laboratory values, LOS, GCS, and management were analyzed.
Results:
Of the 25 patients who met inclusion criteria, 4/25 (16%) asymptomatic patients had a worsened ICH on D-
CTH. One had a change in management due to D-CTH (4%, p=0.16) and underwent craniotomy. The
median GCS of all included patients was 15. Patients who were found to have a worsening ICH had a median
GCS of 14. The single patient, who received a craniotomy as a result of an early repeat CTH, had an
admitting GCS of 9. 3 of 4 patients with worsened incidental D-CTH required no intervention. One patient
was found to have a worsening bleed on 2 nd D-CTH with a stable 3 rd D-CTH. After developing neurologic
changes (aphasia), a 4 th CTH resulted in hematoma evacuation after identifying a worsened ICH.
Conclusion:
Elderly trauma patients taking anticoagulants with an ICH on initial CTH, who have an adequate baseline
mental status and are clinically asymptomatic, do not necessitate routine D-CTH and may over utilize
healthcare resources. D-CTH in patients with a stable, unchanged neurologic exam does not alter clinical
management. In patients with diminished GCS or unreliable neurologic examination obscuring clinical
changes, it may be reasonable to routinely obtain repeat CTH.