Can anticoagulated patients be discharged home safely from the emergency department after minor head injury?

Abstract

Background: Anticoagulated patients have increased risk for bleeding, and serious outcomes could occur after head injury. Controversy exists regarding the utility of head computed tomography (CT) in allowing safe discharge dispositions for anticoagulated patients suffering minor head injury.

Clinical question: What is the risk of delayed intracranial hemorrhage in anticoagulated patients with minor head injury and a normal initial head CT scan?

Evidence review: Four observational studies were reviewed that investigated the outcomes of anticoagulated patients who presented after minor head injury.

Results: Overall incidence of death or neurosurgical intervention ranged from 0 to 1.1% among the patients investigated. The studies did not clarify which patients were at highest risk.

Conclusion: The literature does not support mandatory admission for all anticoagulated patients after minor head injury, but further studies are needed to identify the higher-risk patients for delayed bleeding to determine appropriate management.

Keywords: anticoagulation; head injury; medical imaging; prognosis.