title: Can anticoagulated patients be discharged home safely from the emergency department after minor head injury?
abstract: BACKGROUND
  Anticoagulated patients have increased risk for bleeding, and serious outcomes could occur after head injury. Controversy exists regarding the utility of head computed tomography (CT) in allowing safe discharge dispositions for anticoagulated patients suffering minor head injury.
  
  
  OBJECTIVE
  What is the risk of delayed intracranial hemorrhage in anticoagulated patients with minor head injury and a normal initial head CT scan?
  
  
  METHODS
  Four observational studies were reviewed that investigated the outcomes of anticoagulated patients who presented after minor head injury.
  
  
  RESULTS
  Overall incidence of death or neurosurgical intervention ranged from 0 to 1.1% among the patients investigated. The studies did not clarify which patients were at highest risk.
  
  
  CONCLUSIONS
  The literature does not support mandatory admission for all anticoagulated patients after minor head injury, but further studies are needed to identify the higher-risk patients for delayed bleeding to determine appropriate management.
authors.affiliation: Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Brian
authors.initials: B
authors.lastname: Cohn
authors.affiliation: Department of Emergency Medicine, University of Arizona College of Medicine, Phoenix, Arizona.
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Keim
authors.affiliation: Department of Emergency Medicine, University of Arizona College of Medicine, Phoenix, Arizona.
authors.forename: Arthur B
authors.initials: AB
authors.lastname: Sanders
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D004636:Emergency Service, Hospital; D016489:Head Injuries, Closed / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D019934:International Normalized Ratio; D020198:Intracranial Hemorrhage, Traumatic / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D064887:Observational Studies as Topic; D010351:Patient Discharge; D061214:Patient Safety; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants
keywords: anticoagulation; head injury; medical imaging; prognosis