DOI: 10.36347/sjams.2020.v08i02.056

Pages: 671-680

Background: TBI is one of the leading causes of death and disability in the US irrespective of age, race, gender, ethnicities and economical status and imparts a paramount effect on health system. There are insufficient data to conclude that mild TBI patients on oral anticoagulation with negative initial CT scans could be discharged safely: Methods: We conducted a retrospective study involving anticoagulated patients who had sustained minor head injury ((GCS on admission 13-15; ISS <15); a negative initial head CT scan at a level 2 Regional Trauma Center from October 2013 to December 2017. All patients admitted for at least 24 hours observation with a repeat CT scan performed before discharge; Preinjury use of anticoagulation (warfarin use for at least 1 week). Results: All 61 patients were on Coumadin and (9/61) took aspirin as an additional anticoagulant. The first CT scan was negative in all patients. The second CT scan, performed at ≥6 hours, was positive in 3/61 of the patients. 98% percent of the patients (60/61) had no neurological deterioration during their hospital stay. 92% of patients did not have a CT scan at time 3 or time 4 and 8% of patients (5/61) did have a scan during this period. Of the 5 patients undergoing a CT scan, 3 patients had a positive scan, showing some abnormality. Fifty-four percent of the patients (33/61) had a hospital stay of greater than 3 days. Conclusion: A mean 4 day hospital stay as was evident from our study comprising of elderly patient population would amount to $16,304USD. Excluding the anciliary costs of labs and transport etc. Patients with a mild head injury, a therapeutic INR, and negative initial CT brain can be safely discharged home with close family monitoring, proper education and detailed instructions on when to return.