Citation

Perry JJ, Dowlatshahi D, Eagles D. CJEM 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Canadian Association of Emergency Physicians, Publisher Cambridge University Press)

DOI

10.1007/s43678-022-00429-3

PMID

36481990

Abstract

The population-based study of Ontario older emergency department (ED) patients with head injury published by Liu and colleagues assesses the risk of a delayed intracranial hemorrhage [1]. They found the risk of being diagnosed with a delayed intracranial hemorrhage may be higher in patients on warfarin versus those with no anticoagulation. Further, they found no increased risk of a delayed intracranial hemorrhage for patients on a direct-acting oral anticoagulant (DOAC) therapy versus no anticoagulant. The study did not have individual patient characteristics; therefore, the application of the Canadian CT Head Rule could not be assessed [2]. The Canadian CT Head Rule is not applicable for patients on anticoagulants. In addition, while all patients in this cohort are over 65 years old, they still would only be recommended for imaging by the Canadian CT Head Rule if they met one of the three eligibility criteria: loss of consciousness, amnesia, or confusion associated with their head injury. If not, this would be considered a "minimal" head injury not requiring imaging despite being aged > 65 years [3, 4].

This study assists us with the question, is one CT enough? The Canadian guidelines on the management of older patients following a head injury do not currently exist...

Language: en

Keywords

Anticoagulation; Emergency medicine; Head injury; Intracranial hemorrhage