LO053: Follow-up head CT scan after mild traumatic brain injury: is it really necessary?

Abstract

Introduction: Injured seniors visits are on the rise in the emergency department (ED) and up to 30 % are traumatic brain injury (TBI). Many patients suffer from comorbidities that require the use of anticoagulant drugs. The use of these drugs usually modify the trajectory patients will undergo in the ED. In the last decade, some authors suggested a systematic follow-up CT head scan 8 hours after the initial, while others didn’t see the need to scan, referring only to the clinical features. We sought to evaluate the presence of delayed intracranial bleeding, evolution and investigation at the ED of elderly patients presenting for a mild TBI, with or without anticoagulotherapy. Methods: A retrospective cohort was built with hospital administrative clinical data for year 2014 at a Canadian Level 1 trauma center. Patients 65 years and older with traumatic brain injury and residing in the trauma center catching area were included. Data were extracted from medical files using a standardized collection tool in a consecutive pattern. Patients were classified in three groups: use of anticoagulant drug, use of antiplatelet drug and no anticoagulotherapy. Clinico-administrative data, intervention delay, investigations, comorbidities, medication and physiological status were collected. Intra and extra-hospital data were collected for a period of 90 days and the use of imaging and trajectories were analysed. Univariate and multivariate analysis were conducted. Results: 93 of the 189 TBI injury were mild TBI. The 93 patients were divided in patients using anticoagulotherapy (n = 9, 10 %), using antiplatelet drug (n = 58, 62.4 %) and no use of drug (n = 29, 31.2 %). Each group respectively undergo an initial head CT scan in a proportion of 88.9 %, 93 % and 76 %. Follow-up head CT scan were seen in 43 %, 16 % and 10 %. Delayed intra-cranial hemorrhage were identified in respectively 0 %, 2 % and 0 %. Conclusion: With the increase in patients presenting at Canadian ED for head trauma, our study suggests that anticoagulated elderly patients suffering from a mild traumatic brain injury do not systematically require a follow up CT head scan or longer observation time at the ED. A future clinical decision rule to determine the need of follow-up CT could be of benefit to emergency physicians.