@article{ref1,
title="Delayed intracranial hemorrhage in anticoagulated geriatric patients after ground level falls",
journal="Journal of emergency medicine",
year="2019",
author="Cocca, Alexandra T. and Privette, Alicia and Leon, Stuart M. and Crookes, Bruce A. and Hall, Gregory and Lena, Jonathan and Eriksson, Evert A.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: The 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. <br><br>OBJECTIVE: We hypothesized that there was a significant number of delayed presentations of ICH in patients on NOACs. <br><br>METHODS: A 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. <br><br>RESULTS: Seventy-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. <br><br>CONCLUSIONS: A 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.<br><br>Copyright © 2019 Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0736-4679",
doi="10.1016/j.jemermed.2019.09.011",
url="http://dx.doi.org/10.1016/j.jemermed.2019.09.011"
}