Armando S. Herradura MD, Presenter: Nothing to Disclose

Esther Bilinsky MD, MS, Abstract Co-Author: Nothing to Disclose

Laurie Sophia Sanchez MD, Abstract Co-Author: Nothing to Disclose

To evaluate the diagnostic value of routine repeat head CT (RRHCT) in anticoagulated trauma patients with initial head CT negative for intracranial hemorrhage (ICH).

Utilizing PACS and patient electronic medical records, a retrospective analysis of over 30,000 head CTs performed over a three year period (2011-2013) at a Level I trauma center was conducted. Inclusion criteria were: (1) Documented traumatic injury, (2) Initial head CT negative for ICH, (3) Repeat head CT performed six hours after the initial head CT, and (4) Oral anticoagulation or risk factors for delayed ICH (i.e. abnormal coagulation profile) which per institutional protocol necessitated RRHCT. The hospital course of cases positive for delayed ICH were examined in detail to assess clinical outcomes and identify risk factors related to delayed ICH.

A total of 376 cases met inclusion criteria, with four cases positive for delayed ICH (1.1%). Statistical analysis yields a mean = 0.0107, SD = 0.1027, and 95% CI = 0.0007 – 0.0214. The most common documented forms of anticoagulation and mechanism of injury were aspirin (161 cases) and fall (193 cases), respectively. Clinical management and patient outcomes for two of the four cases of delayed ICH were unaffected by RRHCT. Seizure prophylaxis with Dilantin was performed for the remainder of the hospital course in the third case. For the fourth case, anticoagulation was withheld for the hospital course and commenced after the initial outpatient follow-up.

RRHCT is low in diagnostic value for anticoagulated trauma patients with an initial head CT negative for ICH. RRHCT was negative for delayed ICH in the vast majority of cases, nor did it make significant contributions to patient outcome in all cases of delayed ICH. RRHCT resulted in minor, transient changes in the patients’ medication regiments in two of the four cases and no change in management for the remaining two cases of delayed ICH. Further investigation is required to elucidate if certain forms of anticoagulation or mechanisms of injury predispose patients to delayed ICH.

RRHCT is performed due to theoretical risk of delayed ICH in anticoagulated patients. Current guidelines are scarce due to lack of evidence-based data. We find RRHCT yields minimal benefit at increased cost and radiation exposure.

Herradura, A, Bilinsky, E, Sanchez, L, Head to Head: Evaluating the Utility of Repeat Head CT in the Anticoagulated Trauma Patient.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005785.html