Minor head trauma in anticoagulated patients

Objective: To determine the incidence of clinically significant intracrania l injury in the anti-coagulated patient suffering minor head trauma without loss of consciousness (LOC) or acute neurologic abnormality. Methods: A re trospective chart review was performed based on a computerized search of el ectronic Patient records from six community hospital EDs, one of which is a trauma center. Patients taking warfarin who sustained minor head trauma wi thout LOC having no acute neurologic abnormalities treated from January 199 4 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 resul ts were recorded if obtained. For those patients not receiving a head CT on ED evaluation, telephone follow-up was performed to determine outcome. Res ults: There were 65 patients meeting inclusion criteria. Thirty-eight patie nts 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 h ead CT. Additionally, follow-up on the 26 patients who did not undergo CT s canning revealed no evidence of complications related to their head injurie s. 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 confi rm these findings.