Abstract
BackgroundMild traumatic brain injury is the leading cause of arrivals to emergency department due to trauma in the 65-year-old population and over. Recent studies conducted in ED suggested a low intracranial lesion prevalence. The objectives of this study were to assess the prevalence and risk factors of intracranial lesion in older patients admitted to emergency department for mild traumatic brain injury by reporting in the emergency department the precise anamnesis of injury and clinical findings.MethodsPatients of 65 years old and over admitted in emergency department were prospectively included in this monocentric study. The primary outcome was the prevalence of intracranial lesion threw neuroimaging.ResultsBetween January and June 2019, 365 patients were included and 66.8% were women. Mean age was 86.5 years old (SD = 8.5). Ground-level fall was the most common cause of mild traumatic brain injury and occurred in 335 patients (91.8%). Overall, 26 out of 365 (7.2%) patients had an intracranial lesion. Compared with cutaneous frontal impact (medium risk group), the relative risk of intracranial lesion was 2.54 (95% CI 1.20 to 5.42) for patients with temporoparietal or occipital impact (high risk group) and 0.12 (95% CI 0.01 to 0.93) for patients with facial impact or no cutaneous impact (low risk group). There was not statistical increase in risk of intracranial injury with patients receiving antiplatelets (RR = 1.43; 95% CI 0.68 to 2.99) or anticoagulants (RR = 0.98; 95% CI 0.45 to 2.14).ConclusionAmong patients of 65 years old and over, the prevalence of intracranial lesion after a mild traumatic brain injury was similar to the younger adult population. The cutaneous impact location on clinical examination at the emergency department may identify older patients with low, medium and high risk for intracranial lesion.
Highlights
Mild traumatic brain injury is the leading cause of arrivals to emergency department (ED) due to trauma in the 65-year-old population and over [1, 2]
Current international guidelines are consistent with the large indication of non-contrast head computed tomography scan after Mild traumatic brain injury (mTBI) in patients over 65 years old, even without initial consciousness loss [4, 5]
Older patients showing less specific sign of intracranial lesion following head trauma compared to younger patients, they present less of signs of intracranial hypertension
Summary
Mild traumatic brain injury (mTBI) is the leading cause of arrivals to emergency department (ED) due to trauma in the 65-year-old population and over [1, 2]. Former cohorts from which most international guidelines were derived showed that the intracranial lesions prevalence after mTBI in the elderly was higher than in younger subjects. Regarding to this population, intracranial lesion increased until 30% [6]. Mild traumatic brain injury is the leading cause of arrivals to emergency department due to trauma in the 65-year-old population and over.
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