Is it Time to Ditch the DICH (Delayed Intracranial Hemorrhage) Yet?

TL;DR

This study finds that delayed intracranial hemorrhage is rare in patients on blood thinners who have head trauma, suggesting repeat CT scans may not be needed.

Contribution

The study challenges the routine use of repeat CT scans for DICH in anticoagulated patients without neurological changes.

Findings

Only 0.46% of patients on anticoagulants/antiplatelets with head trauma developed DICH.

Routine repeat CT scans may be unnecessary, reducing hospital stays and costs.

DICH occurred in a patient without significant neurological decline.

Abstract

Background and objective

Delayed intracranial hemorrhage (DICH) is a well-known injury that is rare among patients who are on antiplatelet and/or anticoagulants with head trauma. In this study, we aimed to test the hypothesis that DICH is unlikely to occur without a history of head impact and signs of head and/or face trauma.

Materials and methods

We conducted a two-year (2020-2021) retrospective study regarding the incidence of DICH at our institution. During the study period, our institution had created a protocol specifically for this patient population who possibly suffered head trauma while taking anticoagulants and/or antiplatelets. The primary outcome was the incidence of DICH. The secondary outcome was the association between DICH and signs of head and/or facial trauma. The study protocol was reviewed and approved by the institutional review board committee.

Results

During the study period, there were 259 patients who had suffered head impact while taking anticoagulants and/or antiplatelets. Of them, 225 patients (86.9%) had a negative initial head CT and were admitted for observation. Repeat CT head was performed in 217 patients (96.4%). Among the patients who received a second CT head, only one patient (0.46%) had DICH. The patient did well clinically and did not require any neurosurgical intervention.

Conclusions

Our findings suggest that DICH in patients taking anticoagulants/antiplatelets is unlikely, and a repeat head CT is unnecessary in the absence of changes in neurological status. Thus, it can be concluded that eliminating the routine repeat second CT scan can decrease the length of hospital stay and hospitalization costs. This study's findings highlight the need for more appropriate training related to patients with a history of head impact and signs of head trauma.

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