Head injury is a common cause for presentation to the emergency department (ED) with an incidence quoted as 22.1 per 1000 person-years[1]. There is an increasing number of patients sustaining injury whilst being treated with traditional and novel anticoagulants (NOAC) with increasing number of CT scans of the head requested to exclude intracranial haemorrhage. It is important to manage these patients safely but avoid unnecessary imaging. UK national guidelines (NICE) noted a paucity of evidence in determining whether these patients on NOAC are at increased...

Patients were identified retrospectively from regional RISand PACS for Greater Glasgow and Clyde over a period of 6 weeks (1/1/17 to 18/2/17) following request from the emergency department for CT head with the history of head injury(HI) and anticoagulation. A random sample of 259 (out of 459) patients was selected and those presenting with a suspicion of stroke, seizure or space occupying lesion were excluded (total 59 patients)Fig. 1 . Age No. of patient 70 173 The findings for patients were noted from the original...

200 patients were included - 77 on warfarin, 73 on NOACs and 50 “others” including aspirin ,clopidogrel and dipyridamole Fig. 4 . 5 patients (6.5%) on warfarin, 3 (4.1%) on NOAC and 4 (8%) in the “other” category had intracranial haemorrhage Fig. 5 . Following subgroup exclusion of patients who would have merited CT by other grounds (e.g. low GCS/ intoxication), only 1/30 (3%) patients taking warfarin, 2/24 (8%) of those taking NOAC and 0/12(0%) “others” had intracranial haemorrhage. Even when intracranial haemorrhage was present...

Excluding other factors, anticoagulation alone, particularly with NOAC, poses only low risk of significant intracranial haemorrhage in patients presenting with head injury and as such they may not benefit from routine immediate CT head.

S. Al-Ani; radiology specialty registrar, Greater Glasgow and Clyde/UK - nothing to disclose MA Hunter;consultant radiologist, Royal Alexandra hospital, Glasgow/UK - nothing to disclose CM Cameron;consultant radiologist,Royal Alexandra hospital, Glasgow/UK - nothing to disclose

[1] Herman,G, Samim,M, Peters,H, Schers,H, et al. Incidence, course and risk factors for head injury: a retrospective cohort study.BMJ Open 2018;8:e020364. doi:10.1136/ bmjopen-2017-020364 [2] Head injury: assessment and early management, NICE 2014 clinical guideline CG176 [3] Munakomi, S(2015). A comparative study between Marshall and Rotterdam CT scores in predicting early deaths in patients with traumatic brain injury in a major tertiary care hospital in Nepal. Chinese journal of traumatology, 19(1), 25-27.