Which Patients on Warfarin Need Repeat CT Scan after Head Injury?

MedicalResearch.com Interview with:
Dr Lim Beng Leong MBBS, MRCS (A&E), FAMS

Jurong Health Services
Emergency Department, Singapore 

Medical Research: What is the background for this study? What are the main findings?

Dr. Leong: It is common in the emergency department to see patients with warfarin who suffer a minor head injury (HI) with GCS >13. It is standard practice according to international guidelines to perform a plain CT scan of the head. What is contentious in the literature is the subsequent management of those patients with a normal initial CT scan. Practice is heterogeneous and includes a mandatory second CT scan at 24 hours mark or observation and repeat CT scan at the discretion of the attending doctor.

We have found in our study that the “observe and repeat CT scan for symptomatic cases” approach only was safe as abnormal second CT scans were rare (1 in 295 cases). We traced the patients’ course 2 weeks post discharge and none of the patients were re-admitted for reasons of delayed intra-cranial hemorrhage (ICH).

However, the cohort of patients consist largely of geriatric patients with falls. More than 50% of these patients were hospitalized for more than 3 days; the longest of 2-3 weeks. They were likely to have various reasons that required longer hospitalizations apart from observation for delayed ICH, such as assessing for risk, etc.

Medical Research: What should clinicians and patients take away from your report?

Dr. Leong: The main message to take home is that observation and repeat CT scan was safe in patients with minor head injury and warfarin. However, the duration and mode of observation (i.e a structured program inpatient or outpatient) for this largely geriatric patients with fall as presenting complaint remain to be determined.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Leong: Future research should look at reasons why these geriatric patients need prolonged hospitalization and only through understanding these reasons, each clinical service can devise a thorough yet targeted screening and assessment program which can be inpatient or outpatient to manage them who present with HI from a seemingly trivial fall.


Outcomes of warfarinized patients with minor head injury and normal initial CT scan

Leong, Lim Beng et al.

The American Journal of Emergency Medicine

DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.009

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Dr Lim Beng Leong (2015). Which Patients on Warfarin Need Repeat CT Scan after Head Injury?