Traumatic brain injury causes significant morbidity, mortality, and at least 2.5 million yearly emergency department visits in the US. While CT of the head remains the gold standard for detecting traumatic intracranial hemorrhage, there is growing interest in understanding delayed intracranial hemorrhage in seniors. When a bleed is not identified on the original scan but occurs later, it is referred to as a “delayed intracranial hemorrhage.”

A recent study published in the International Journal of Emergency Medicine concluded that traumatic delayed intracranial hemorrhage is rare and generally has mild consequences Delayed intracranial hemorrhage after head trauma seems rare and rarely needs intervention—even in antiplatelet or anticoagulation therapy | International Journal of Emergency Medicine | Full Text (biomedcentral.com). The findings suggest that the previous recommendation of rescanning patients on anticoagulation or antiplatelet therapy may warrant reevaluation.

However, a separate study led by Dr. Richard Shih, professor of emergency medicine at Florida Atlantic University, followed patients presenting to the ER with head trauma while on anticoagulation therapy. Although initial CT scans in the ER were negative, a repeat CT at 24 hours and inpatient observation for a week revealed that over 7% of patients experienced delayed head bleeds Delayed Bleeding: The Silent Risk for Seniors (medscape.com).

Research is invaluable, but the key takeaway is to know your residents well. Detecting subtle changes early can prevent problems from becoming significant. Be vigilant and proactive in monitoring residents at risk.

Stay well and stay informed!