Isolated Cerebral Contusion and Limited Subarachnoid Hemorrhage on Head CT Scanning for Minor Blunt Head Trauma Is Clinically Important

BackgroundAntiplatelet agents are increasingly used in cardiovascular treatment. Limited research has been performed into risks of acute and delayed traumatic intracranial hemorrhage (ICH) in these patients who sustain head injuries. Our goal was to assess the overall odds and identify factors associated with ICH in patients on antiplatelet therapy.MethodsA retrospective observational study was conducted at two level I trauma centers. Adult patients with head injuries on antiplatelet agents were enrolled from the hospitals’ trauma registries. Acute ICH was diagnosed by head CT. Observation and repeat CT to evaluate for delayed ICH was performed at clinicians’ discretion. Patients were stratified by antiplatelet type and analyzed by ICH outcome.ResultsOf 327 patients on antiplatelets who presented with blunt head trauma, 133 (40.7%) had acute ICH. Three (0.9%) had delayed ICH on repeat CT, were asymptomatic and did not require neurosurgical intervention. One with delayed ICH was on clopidogrel and two were on both clopidogrel and aspirin. Patients with delayed ICH compared with no ICH were older (94 vs 74 years) with higher injury severity scores (15.7 vs 4.4) and trended towards lower platelet counts (141 vs 216). Patients on aspirin had a higher acute ICH rate compared with patients on P2Y12 inhibitors (48% vs 30%, 18% difference, 95% CI 4 to 33; OR 2.18, 95% CI 1.15 to 4.13). No other group comparison had significant differences in ICH rate.ConclusionsPatients on antiplatelet agents with head trauma have a high rate of ICH. Routine head CT is recommended. Patients infrequently developed delayed ICH. Routine repeat CT imaging does not appear to be necessary for all patients.Level of evidenceLevel III, prognostic.

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Metro Stroke Task Force Survey of Resources for Diagnosis of Non-Traumatic Subarachnoid Hemorrhage

Stroke ◽

10.1161/str.32.suppl_1.340-e ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 340-340

Author(s):

Scott P Duffy ◽

Scott Silliman ◽

Thomas G Brott ◽

Zachery Richardson ◽

Robert Wharen ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Subarachnoid Hemorrhage ◽

Task Force ◽

Diagnostic Errors ◽

Ct Scanning ◽

Slice Thickness ◽

Blood Products ◽

Head Ct ◽

Csf Analysis ◽

Specific Protocol

P9 Background: Up to 25 percent of patients with subarachnoid hemorrhage (SAH)initially receive an incorrect diagnosis. Potential limitations to initially diagnosing SAH include insufficient resources and non-standardized utilization of existing resources. We performed a population-based study to assess adherence to recommendations regarding computed tomography (CT) scanning and cerebrospinal fluid (CSF) analysis as cited in a recent publication. Methods: We approached all hospitals with operational emergency departments within a 50 mile radius of downtown Jacksonville, FL. Each facility was contacted by phone or in person by one of two members of the Metro Stroke Task Force (SPD,SS). Included in the survey were groups of questions each directed to a physician or technician best qualified to provide appropriate information. We used the recommendations cited by Edlow and Caplan as a benchmark for diagnosing SAH acutely (cf. New Engl J Med 2000; 342:29–36). Specifically addressed were the axial imaging slice thickness on head CT and methods for analyzing cerebrospinal fluid for blood and blood products. Results: 13 of 13 (100%) hospitals responded. 7 of 13 (54%) have 200 or more beds. 10 of 13 (77%) have neurosurgeons on staff. None (0%) of the hospitals surveyed cited a specific protocol for head CT scanning or CSF analysis in the evaluation of suspected subarachnoid hemorrhage. One (7.7%) hospital used CT cuts as thin at the base of the brain as the 3mm recommended. None (0%) of the hospitals routinely used spectrophotometry to evaluate for the presence of xanthochromia in CSF when ruling out SAH. Conclusion: We found that there is not a uniform and specific way to approach the diagnosis of SAH among all of the institutions that provide acute care within a 50 mile radius of Jacksonville. Areas for improvement in delivery of care might include standardized protocols for CT acquisition and CSF analysis for blood and blood products. Such standardized measures may reduce the potential for initial diagnostic errors.

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