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Treatment of mild traumatic brain injury (mTBI)/concussion is usually handled by emergency medicine and primary care physicians or the injured person might not seek medical care. When a patient is evaluated, imaging may not be not required if the neurologic examination is normal. However, if there are focal neurologic deficits, vomiting, headache, coagulopathy, age >60 years, outward evidence of head or neck trauma, intoxication, or a dangerous mechanism of trauma, then head CT or brain MRI is recommended. In situations where a patient has an initially negative head CT without any residual signs or symptoms, discharge from the emergency department (ED) is considered safe. However, this is not the case for patients on anticoagulation—immediate discharge from ED after a normal head CT may not be appropriate.1 Traumatic brain injury (TBI) affects more than 1.7 million Americans yearly, and the proportion of Americans on anticoagulation is increasing (prescriptions at outpatient visits are up 38% from 2009 to 2014), so that more physicians are being faced with this dilemma without much literature to guide them.2,3 Due to unknown rates of delayed intracranial hemorrhage (ICH), providers typically err on the side of caution and allow for a prolonged period of observation and obtain repeat head imaging.
Footnotes
Funding information and disclosures are provided at the end of the editorial. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.
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