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J Trauma. 2003 Mar;54(3):492-6.

Time to deterioration of the elderly, anticoagulated, minor head injury patient who presents without evidence of neurologic abnormality.

Author information

  • 1Department of Surgery, Mary Imogene Bassett Hospital, Cooperstown, New York 13326, USA. reynoldsf@aol.com

Abstract

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.

PMID:
12634528
[PubMed - indexed for MEDLINE]
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