Possible limited justification for systematic head computed tomography scans based solely on antithrombotic therapy in elderly patients (aged 75 or older) with mild traumatic brain injury

Abstract

Rationale and objectives

Recent literature suggests that performing systematic head computed tomography (CT) scans for mild traumatic brain injury (mTBI) in patients undergoing antithrombotic therapy offers limited benefits. This study aims to evaluate a set of criteria that could potentially eliminate the need for systematic head CT scans, performed solely because of the antithrombotic treatment status, in elderly patients (aged 75 or older) presenting with mTBI.

Materials and methods

All patients aged 75 or older who underwent a head CT scan at our academic center for mTBI while on antithrombotic therapy between January and December 2022 were retrospectively included in this study. Patients were categorized into two groups. The first group, referred to as the “At-risk group”, included patients with any of the following: GCS score < 15 or cognitive impairment; initial loss of consciousness; hemodynamic instability; signs of fractures; extensive subcutaneous hematoma; severe or treatment-resistant headache; vomiting; seizure; any neurological deficit; intoxication; amnesia; or a history of neurosurgery. The second group, referred to as the “Not-at-risk group”, comprised patients without any of these criteria.

Results

A total of 1415 patients were included. Post-traumatic intracranial hemorrhage (P < 0.001), brain herniation (P = 0.003), and fractures (P < 0.001) occurred statistically more frequently in the At-risk group. Six post-traumatic hemorrhagic brain injuries were found in the Not-at-risk group, that did not present any of the studied criteria, and all these injuries were minor (localized SAH; millimetric SDH). Furthermore, none of these required immediate or delayed surgical intervention, and no neurological deterioration or deaths occurred in these patients.

Conclusion

In conclusion, conducting systematic head CT scans based solely on antithrombotic therapy in elderly patients aged 75 or older with mTBI might be irrelevant.