EM Basic Essential Evidence- Admission for patients with minor head injury on coumadin- Annals of EM

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4.6 • 665 Ratings

🗓️ 3 September 2012

⏱️ 8 minutes

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Summary

In this episode, we'll talk about a recent article in Annals of Emergency Medicine that has a lot of people talking. This is a study that looked at patients on coumadin (warfarin) who had minor head injuries. The patients were admitted for 24 hours of observation and had a repeat head CT. The study looked at how many patients had bleeding on a repeat head CT and the conclusions were suprising. Should this be our new standard of care? Maybe but maybe not.

Transcript

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0:00.0	This is Steve Carroll, and you're listening to EM Basic Essential Evidence.
0:04.7	Today we'll be talking about a relatively recent article in the aisles of emergency medicine.
0:09.3	The title of the article is,
0:11.2	Management of Minor Head Injury in Patients Receiving Oral Anticoagulation Therapy,
0:16.6	a prospective study of a 24-hour observation protocol.
0:20.7	Once again, this was published in the Annals of Emergency Medicine, June 2012,
0:25.6	and the first author is Dr. Vincenzo Mendetto.
0:29.2	I probably mispronounce that, sorry.
0:30.9	As always, his podcast doesn't represent the views or opinions of the Department of Defense,
0:34.2	the U.S. Army, or the Fort Hood Post Command.
0:36.8	So here's the background on
0:37.9	this issue. Patients on oral antiquaglants, such as warfarin, who sustain even a minor head
0:43.5	injury, frequently get a non-contrast head CT as part of their workup because intracranial
0:49.2	hemorrhage is common in these patients. Rates vary anywhere from 7 to 25%. Also, delayed intracranial hemorrhage up to a week
0:57.1	later has been reported in these patients. So the question is, what is the utility of emitting
1:02.7	patients on Coumadin with minor head trauma for further observation and a repeat head CT in 24 hours?
1:09.5	So let's talk first about the study design.
1:11.9	So this was a single center prospective observational study.
1:15.8	This means that patients were admitted to a single hospital
1:18.1	and then followed to see their outcome.
1:21.0	One important thing to remember is the difference between prospective and retrospective studies.
1:26.3	Prospective means that you defined a set of study criteria ahead of time, found some way to
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