One prospective cohort study of 859 older adults (>55 years of age) with head trauma and a negative CT found a very low rate (3 cases or 0.3%) of delayed traumatic ICH within 14 days, and only 1 of the 3 cases occurred in a patient on anticoagulant or antiplatelet medication (warfarin with a positive repeat CT at 5 days) [35]. The authors conclude the risk of delayed ICH is low, even on anticoagulant or antiplatelet medication, and does not merit routine observation and repeat CT; however, the study is limited by the small number of patients in each anticoagulant and antiplatelet group. CTA Head and Neck There is no relevant literature to support the use of CTA in the short-term follow-up imaging evaluation of acute head trauma without suspected vascular injury (see Variants 8 and 9 when suspected). FDG-PET/CT Brain There is no relevant literature to support the use of FDG-PET/CT in the short-term follow-up imaging evaluation of acute head trauma. HMPAO SPECT or SPECT/CT Brain There is no relevant literature to support the use of SPECT in the short-term follow-up imaging evaluation of acute head trauma. MR Spectroscopy Head There is no relevant literature to support the use of MRS in the short-term follow-up imaging evaluation of acute head trauma. Head Trauma MRA Head and Neck There is no relevant literature to support the use of MRA in the short-term follow-up imaging evaluation of acute head trauma. MRI Functional (fMRI) Head There is no relevant literature to support the use of fMRI in the short-term follow-up imaging evaluation of acute head trauma. MRI Head Although brain MRI is not the most useful initial imaging modality for the evaluation of acute head trauma, it may be indicated as a follow-up study when there are persistent neurologic deficits that remain unexplained after the head CT [2]. MRI is more sensitive than CT for subtle findings adjacent to the calvarium or skull base (eg, small cortical contusions and subdural hematomas) [29].
Head Trauma PCAs. One prospective cohort study of 859 older adults (>55 years of age) with head trauma and a negative CT found a very low rate (3 cases or 0.3%) of delayed traumatic ICH within 14 days, and only 1 of the 3 cases occurred in a patient on anticoagulant or antiplatelet medication (warfarin with a positive repeat CT at 5 days) [35]. The authors conclude the risk of delayed ICH is low, even on anticoagulant or antiplatelet medication, and does not merit routine observation and repeat CT; however, the study is limited by the small number of patients in each anticoagulant and antiplatelet group. CTA Head and Neck There is no relevant literature to support the use of CTA in the short-term follow-up imaging evaluation of acute head trauma without suspected vascular injury (see Variants 8 and 9 when suspected). FDG-PET/CT Brain There is no relevant literature to support the use of FDG-PET/CT in the short-term follow-up imaging evaluation of acute head trauma. HMPAO SPECT or SPECT/CT Brain There is no relevant literature to support the use of SPECT in the short-term follow-up imaging evaluation of acute head trauma. MR Spectroscopy Head There is no relevant literature to support the use of MRS in the short-term follow-up imaging evaluation of acute head trauma. Head Trauma MRA Head and Neck There is no relevant literature to support the use of MRA in the short-term follow-up imaging evaluation of acute head trauma. MRI Functional (fMRI) Head There is no relevant literature to support the use of fMRI in the short-term follow-up imaging evaluation of acute head trauma. MRI Head Although brain MRI is not the most useful initial imaging modality for the evaluation of acute head trauma, it may be indicated as a follow-up study when there are persistent neurologic deficits that remain unexplained after the head CT [2]. MRI is more sensitive than CT for subtle findings adjacent to the calvarium or skull base (eg, small cortical contusions and subdural hematomas) [29].