Our current practice from the minor injuries unit (where many of our OAP's visit)
is to transfer to Scarborough warfarinised patients with any symptoms. That
is the protocol, but given the sparsity of such transfers and the frequency
of all other drunk head injury transfers from the same site (why do "Wessies"
insist on getting plastered and injured in Bridlington?)I suspect that the protocol
is not followed or else the incidence (even in a holiday resort favoured by
those who can't cope with the hills of Scarborough or Whitby and therefore would
be more likely to be on warfarin)is remarkably low. Obviously a potential audit
for my staff grades there!
o, do you admit all patients on warfarin who have had a minor head injury
>with no LOC? e.g. 1 cm superficial cut over forehead glued and no symptoms?
>If they are admitted I presume they would have to travel by ambulance from
>Bridlington to Scarborough for HI obs?
>
>I have similar problems with distances re Kendal and Lancaster 23 miles
>away.
>
>Ray
>
>----- Original Message -----
>From: <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Friday, February 01, 2002 7:17 PM
>Subject: Warfarin and Minor head Injury
>
>
>> I published a little paper in JAEM May 98, vol15(3)p159-161 on this topic.
>It
>> was based on a clinical topic review for the FFAEM. We had 3 departmental
>cases
>> of intracranial bleeding in warfarinised patients with minor head injuries
>in
>> 3 months. Two of three had INR of 2.2. The other was not recorded. All had
>symptoms
>> especially headache, on first attending. I found 8 other cases published.
>These
>> all had significantly raised INR (above planned levels)or symptoms. My
>reading
>> suggests that being on warfarin is supposed to raise the risk of
>spontaneous
>> haemorrahge by 10 ( NO RCT). I applied the 10 factor to the Glasgow risk
>of
>> ICH in head injury: Fully orientated , no fracture 1:800 Confused, no
>fracture
>> 1:18, Orientated plus fracture 1:4, Confused plus fracture 2:1!! My bottom
>line
>> is Head injury plus warfarin, check INR. If elevated out of treatment
>range,
>> admit under medics for control. If normal treatment range, any symptoms
>need
>> CT. The timing of this is not clear, since bleeding may occur after the CT
>but
>> treat a symptomatic patient seriously and have a low threshold for scan.
I
>need
>> a trial to see if this helps, but given each A&E only sees a couple of
>these
>> a year, I haven't managed to organise such a study. Any of you academics
>out
>> there looking for a project? I am sure we could tame a neurosurgeon
>sufficiently
>> to get a retrospective study of warfarin and ICranialH (EDH, SDH and ICH.
>When
>> I was SR the local team were keen but had terrible record storage making
>it
>> impossible to find cases.
>>
>
>
>
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