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Time to Deterioration of the Elderly, Anticoagulated, Minor Head Injury Patient Who Presents without Evidence of Neurologic Abnormality

Reynolds, Frederick D. MD; Dietz, Patrick A. MD; Higgins, Diane RN; Whitaker, Timothy S. MD

The Journal of Trauma: Injury, Infection, and Critical Care: March 2003 - Volume 54 - Issue 3 - p 492-496
doi: 10.1097/01.TA.0000051601.60556.FC

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.

Conclusion  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.

From the Departments of Surgery (F.D.R., D.H., T.S.W.) and General and Vascular Surgery (P.A.D.), Mary Imogene Bassett Hospital, Cooperstown, New York.

Submitted for publication October 29, 2000.

Accepted for publication November 25, 2002.

Address for reprints: Frederick D. Reynolds, MD, Department of Surgery, Mary Imogene Bassett Hospital, One Atwell Road, Cooperstown, NY 13326; email:

© 2003 Lippincott Williams & Wilkins, Inc.