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A sobering personal experience has convinced me to CT scan all G.C.S 15 head injury patients on warfarin independent of their PT-INR.If its an acute presentation it means a CT Head and admission for observation till improvement of the minor symptoms(usually headache)with consideration to a repeat scan if symptoms worsen.If its a delayed presentation(few days after the injury) its CT head and home if scan is normal with usual HI advise.On evidence,a fellow registrar(now consultant)did one of his topic reviews on the subject of management of warfarinised patients with minor head injury and might want to share his opinion with the list(unless he has already submitted it for publication!)To my knowledge,there are no prospective studies only case reports and retrospective record reviews.The latest I found was a research letter by Li and Brown reported in the Lancet(THE LANCET Vol 357 March 10 2001)recommending CT scan in all patients with head injury receiving anticoagulants.It refuted the earlier work by Garra(Minor head injury in the warfarinised patient-Acad Emergency Med 1999 Feb;6(2) 121-4)which seemed to suggest CT scan may be unnecessary in the anticoagulated patient with minor blunt head injury.Personally I don't see the numbers being large if we did go ahead and scan all those who present and it could be part of a multi centre prospective trial to settle the question once and for all.I suggest we call it the WITHMI Study(Warfarin In Traumatic Head-Minor Injury).Are you with me? Dilip Menon North Wales