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. 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.