Head Injury While Taking Baby Aspirin: Emergency Department Evaluation Recommended
Yes, you should go to the Emergency Room for evaluation with a head CT scan if you hit your head while taking baby aspirin, particularly if you experienced loss of consciousness, have persistent headache, confusion, or are over 60 years old. 1
Risk Assessment for Aspirin Users
While the evidence regarding baby aspirin (low-dose aspirin) and head trauma is limited, the available data suggests:
Baby aspirin alone carries lower bleeding risk than other anticoagulants or antiplatelet agents (like clopidogrel or warfarin), but still increases intracranial hemorrhage risk compared to no anticoagulation. 1
The 2023 American College of Emergency Physicians guidelines specifically note that insufficient evidence exists to make definitive recommendations about aspirin-only users after head trauma, as most studies had too few aspirin-only patients to draw conclusions. 1
Research shows low-dose aspirin increases overall intracranial bleeding risk by 37% (relative risk 1.37), with approximately 2 additional intracranial hemorrhages per 1,000 people. 2
When Emergency Evaluation is Mandatory
Seek immediate ER evaluation if you have any of these features after head injury while on aspirin:
- Loss of consciousness (even brief) 1
- Persistent or worsening headache 1
- Confusion, disorientation, or memory problems 1
- Age 60 years or older (significantly higher risk) 1, 3
- Vomiting 1
- Visible signs of skull fracture (bruising behind ears, raccoon eyes, clear fluid from nose/ears) 1
- Seizure activity 1
- Focal neurological deficits (weakness, numbness, vision changes, speech problems) 1
Clinical Decision-Making Algorithm
Step 1: Assess injury severity
- If Glasgow Coma Scale score is less than 15 (any confusion, disorientation, or altered consciousness), immediate ER evaluation with head CT is required. 1
Step 2: Apply high-risk criteria
- Age ≥60 years automatically qualifies as high-risk requiring imaging, regardless of other factors. 1, 3
- Dangerous mechanism of injury (fall from height, motor vehicle collision, assault) warrants evaluation. 1
Step 3: Consider observation period
- Even with normal initial presentation, delayed intracranial hemorrhage can occur in patients on antiplatelet agents, though this is rare with aspirin alone. 1
- Historical data shows aspirin increases risk of chronic subdural hematoma development. 4
Important Clinical Nuances
Aspirin differs from other anticoagulants:
- Studies examining warfarin and clopidogrel show delayed intracranial hemorrhage rates of 0.6% and 0% respectively after normal initial CT scans. 1
- Aspirin-only patients had insufficient numbers in major studies to determine if they require routine observation or repeat imaging after normal initial CT. 1
- One study found no increased surgical intervention rates in aspirin users over 60 with mild-moderate head injury (4.5% vs 4.1% in controls). 3
Age-related considerations:
- Patients over 60 on low-dose aspirin with even minor head trauma (Glasgow Coma Scale 15) showed intracranial hemorrhage on CT in 11.5% of cases, though none required surgery. 3
- Asian race/ethnicity and low body mass index further increase intracerebral hemorrhage risk with aspirin use. 2
Common Pitfalls to Avoid
Do not assume "baby aspirin" is safe enough to skip evaluation if high-risk features are present—the evidence is insufficient to support this approach. 1
Do not rely solely on absence of symptoms immediately after injury—delayed hemorrhage, while rare, can occur hours later. 1
Do not continue aspirin after documented intracranial hemorrhage without explicit neurosurgical clearance, as rebleeding mortality can equal or exceed cardiac event mortality. 5
What to Expect at the ER
If you go to the ER, expect:
- Initial head CT scan to evaluate for intracranial bleeding. 1
- Neurological examination including Glasgow Coma Scale assessment. 1
- Possible observation period of 4-24 hours with repeat imaging if initial CT is normal, depending on your specific risk factors and institutional protocols. 1
- The decision for observation versus discharge will depend on your age, mechanism of injury, symptoms, and CT findings. 1
When Observation May Be Reasonable
If you are under 60 years old, have no loss of consciousness, no persistent symptoms, and a low-risk mechanism (minor bump), some clinicians may consider observation at home with strict return precautions. However, this approach lacks strong evidence support for aspirin users specifically. 1 When in doubt, err on the side of ER evaluation—the consequences of missed intracranial hemorrhage are severe.