An anticoagulated patient is at risk for serious intracerebral hemorrhage after even minor head injury. A patient may present with normal neurologic findings only to rapidly deteriorate and die.
Risk factors for serious bleeding:
(1) age >= 65 years of age
(2) severity of head injury
(3) degree of anticoagulation
The typical patient at risk is receiving coumadin, but a patient taking aspirin or other antiplatelet agent may be at increased risk.
The following score is proposed to try to use these risk factors:
|
Parameter |
Findings |
Points |
|
age of the patient |
< 65 years |
0 |
|
|
>= 65 years |
1 |
|
severity of head injury |
minor |
0 |
|
|
moderate |
1 |
|
|
severe |
2 |
|
degree of anticoagulation |
subtherapeutic |
0 |
|
|
therapeutic |
1 |
|
|
high therapeutic |
2 |
|
|
excessive |
3 |
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• The higher the score the greater the risk of significant intracranial hemorrhage.
|
Total Score |
Risk of Significant Intracranial Bleeding |
|
0 |
low to moderate |
|
1 |
moderate |
|
2 |
moderate to high |
|
3 |
high |
|
4 |
very high |
|
5 or 6 |
extremely high |
Purpose: To evaluate an anticoagulated patient after head injury for the risk of significant intracerebral hemorrhage.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general, Otolaryngology
Objective: risk factors, severity, prognosis, stage, complications
ICD-10: I61, S00-S09,
