• J Emerg Med · Dec 2019

    Delayed Intracranial Hemorrhage in Anticoagulated Geriatric Patients After Ground Level Falls.

    • Alexandra T Cocca, Alicia Privette, Stuart M Leon, Bruce A Crookes, Gregory Hall, Jonathan Lena, and Evert A Eriksson.
    • Division of Trauma and Critical Care, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
    • J Emerg Med. 2019 Dec 1; 57 (6): 812-816.

    BackgroundThe reported risk of delayed intracranial hemorrhage (ICH) in a trauma patient on warfarin is estimated to be between 0.6% and 6%. The risk of delayed ICH in trauma patients taking novel oral anticoagulants (NOACs) is not well-defined.ObjectiveWe hypothesized that there was a significant number of delayed presentations of ICH in patients on NOACs.MethodsA retrospective review of our trauma registry was performed on geriatric patients (age older than 64 years) who were initially evaluated at our level I trauma center, had fall from standing height or less, and were anticoagulated (warfarin or NOACs), from April 2017 to March 2018.ResultsSeventy-seven patients met inclusion criteria. The mean age was 80 ± 7.7 years and 46% of patients were male. The admission head computed tomography scan was positive in 20.8% of patients. Positive scans were more common in patients on warfarin vs. NOACs (30% vs. 14%; p = 0.074) and had a significantly higher Injury Severity Score (median [interquartile range]: 9 [3-15] vs. 5 [1-9]; p = 0.030) and Abbreviated Injury Scale-Head score (median [interquartile range]: 1 [0-3] vs. 1 [0-2]; p = 0.035). The agreement between loss of consciousness (LOC) and ICH was 72% (κ = -0.064; p = 0.263). Fifty-one percent of patients had a repeat head CT. New ICH was diagnosed in 9.6% of patients. All of these patients were on NOACs.ConclusionsA fall from standing or less in anticoagulated geriatric patients is a significant mechanism of injury resulting in ICH. The absence of LOC does not eliminate the possibility of ICH. There is a significant risk of delayed ICH for patients on NOACs and repeat evaluations should be performed. A prospective multicenter evaluation of this finding is warranted.Copyright © 2019 Elsevier Inc. All rights reserved.

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