Repeat Head CT or Admission for Delayed Head Bleed Is Wasteful

Delayed intracranial hemorrhage after a negative initial head computed tomography (CT) scan is a rare but potentially devastating phenomenon in patients with blunt head injury. Some clinicians recommend a period of hospitalization and observation or repeat head CT, especially in older patients or those taking anticoagulant medications, but this practice is controversial.

These authors prospectively followed 859 patients aged 55 and older with head injury who were transported by emergency medical services to 11 hospitals in California and had initial negative head CT scans. Patients were followed up by phone at 14–28 days. The main outcome was incidence of delayed intracranial hemorrhage identified by CT within 14 days of injury.

Three patient…