Time to deterioration of the elderly, anticoagulated, minor head injury patient who presents without evidence of neurologic abnormality.
BACKGROUND
Generally accepted guidelines regarding the care of the elderly, anticoagulated minor head injury patient do not exist within the trauma literature.


METHODS
Charts were reviewed on all anticoagulated, minor head injury patients older than 65 years between January 1993 and May 2000. Postinjury course was examined for neurologic changes, times, coagulation/radiographic studies, reversal, operative intervention, and outcome.


RESULTS
Thirty-two patients were identified. Twenty-four patients were discharged from the Emergency Department. Three of the remaining eight patients had initial Glasgow Coma Scale scores of 15, 15, and 14 but became comatose over a mean course of 3.83 hours. A fourth patient presented comatose 6 hours postinjury, down from "acting normal." Three of these four patients died.


CONCLUSIONS
Elderly, anticoagulated patients with minor head trauma risk neurologic deterioration within 6 hours of injury, despite an initially normal neurologic examination. Early cranial computed tomographic scanning and close observation for a minimum of 6 hours are indicated.
Reynolds
Frederick D
FD
Department of Surgery, Mary Imogene Bassett Hospital, Cooperstown, New York 13326, USA. reynoldsf@aol.com
Dietz
Patrick A
PA
Higgins
Diane
D
Whitaker
Timothy S
TS
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D006259:Craniocerebral Trauma / Q000150:complications / Q000401:mortality / Q000628:therapy; D005260:Female; D015577:Geriatric Assessment; D005853:Geriatrics; D015600:Glasgow Coma Scale; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008499:Medical Records
D000925:Anticoagulants