• Ben HaimGalGDepartment of Emergency Medicine, Sheba Medical Center, Ramat-Gan, Israel; Tel Aviv University, Faculty of Medical & Health Sciences, Tel Aviv, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: galushbh@gm, Li Ram, Mor Saban, Liat Toderis, Bernice Oberman, Avinoah Irony, and Avi Epsztein.
• Department of Emergency Medicine, Sheba Medical Center, Ramat-Gan, Israel; Tel Aviv University, Faculty of Medical & Health Sciences, Tel Aviv, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: galushbh@gmail.com.
• Am J Emerg Med. 2024 Oct 1; 84: 939793-97.

BackgroundMild traumatic brain injuries (mTBIs) pose a significant risk, particularly in the elderly population on anticoagulation therapy. The safety of discharging these patients from the emergency department (ED) with a negative initial computed tomography (CT) scan has been debated due to the risk of delayed intracranial hemorrhage (d-ICH).ObjectiveTo compare outcomes, including d-ICH, between elderly patients on anticoagulation therapy presenting with mTBI who were admitted versus discharged from the ED after an initial negative head CT scan.MethodsWe conducted a retrospective observational study at the Chaim Sheba Medical Center, assessing outcomes of 1598 elderly patients on anticoagulation therapy who presented with mTBI and an initial negative head CT scan. Patients were either admitted for 24-h observation (Group A, n = 829) or discharged immediately from the ED (Group B, n = 769). The primary outcome was incidence of d-ICH within 14 days.ResultsAmong the 1598 patients included in the study, 46 admitted patients and 1 discharged patient returned within 14 days for repeat CT, identifying one asymptomatic hemorrhage in the discharged patient. Mortality at 30 days was significantly higher in admitted patients compared to discharged patients (4.8% vs. 1.8%, p = 0.001), though cause of death was unrelated to head injury in both groups.ConclusionIn elderly patients on anticoagulation with mTBI and a negative initial CT, admission was associated with a higher risk of d-ICH compared to discharge. These findings have implications for clinical decision-making in this high-risk population.Copyright © 2024 Elsevier Inc. All rights reserved.

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