Abstract
BackgroundFalls are a common cause of hospitalization, morbidity, and mortality among the elderly in the United States. Evidence-based imaging recommendations for evaluation of delayed intracranial hemorrhage (DICH) are not generally agreed upon. The purpose of this project was to evaluate the incidence of DICH detected by head computer tomography (CT) among an elderly population on pre-injury anticoagulant or antiplatelet (ACAP) therapy.MethodsData from a Level 1 Trauma Center trauma registry was used to assess the incidence of DICH in an elderly population of patients (≥65 years) who sustained a minor fall while on pre-injury ACAP medications. Counts and percentages are reported.ResultsData on 1076 elderly trauma patients were downloaded, of which 838 sustained a minor fall and 513 were found to be using a pre-injury ACAP medication. One patient (0.46%) with a DICH was identified out of 218 patients who received a routine repeat head CT. Aspirin and warfarin were the most common pre-injury ACAP medications and 19.27% (42/218) of patients were found to be using multiple ACAP medications.ConclusionsUniversal screening protocols promote immediate-term patient safety, but do so at a great expense with respect to health expenditures and increased radiation exposure. This analysis highlights the need for an effective risk assessment tool for DICH that would reduce the burden of unnecessary screenings while still identifying life-threatening intracranial hemorrhages in affected patients.
Highlights
Falls are a common cause of hospitalization, morbidity, and mortality among the elderly in the United States
Rates of immediate traumatic intracranial hemorrhage following a traumatic injury identified by head computer tomography (CT) scan vary in the literature, ranging from 5.1–29.1% [7,8,9,10,11,12,13]
Head CT utilization, results, and medication data were abstracted from the medical record, while all other data elements came from the trauma registry
Summary
Falls are a common cause of hospitalization, morbidity, and mortality among the elderly in the United States. Evidence-based imaging recommendations for evaluation of delayed intracranial hemorrhage (DICH) are not generally agreed upon The purpose of this project was to evaluate the incidence of DICH detected by head computer tomography (CT) among an elderly population on pre-injury anticoagulant or antiplatelet (ACAP) therapy. Prior studies have concluded that rates of DICH in elderly injured patients on pre-injury ACAP medications are low, ranging from 0 to 6% [8, 9, 13, 16,17,18,19]. Most of these analyses have considered limited panels of ACAP medications and have not
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