Mild head trauma in elderly patients: experience of an emergency department

Gabriele Savioli,Iride Francesca Ceresa,Luca Ciceri,Fabio Sciutti,Mirko Belliato,Giorgio Antonio Iotti,Sabino Luzzi,Mattia Del Maestro,Gianluca Mezzini,Elvis Lafe,Anna Simoncelli,Giovanni Ricevuti,Federica Manzoni,Maria Antonietta Bressan

doi:10.1016/j.heliyon.2020.e04226

Abstract

IntroductionWe evaluated the risk profile of elderly patients who came to the emergency department for mild head trauma. The primary goal was to determine the difference in the incidence of posttraumatic intracranial hemorrhage (ICH) after minor head injury (MHI). The secondary objective was to assess worse outcome, such as: hospitalization rate, rate of re-admission, need of neurosurgery. We also assess the admission process times and length of hospital stay. The ultimate goal was to optimize the diagnostic-observational management of minor head trauma in elderly patients. Material and methodsWe evaluated all patients with MHI who came to our emergency department during 2017 and 2018. All patients underwent computed tomography. ResultsWe enrolled 2325 patients, of whom 1094 were 75 years of age or older. The population was divided into two categories according to age: The “elderly population” was 75 or older, and the younger patients were younger than 75. The elderly population, in comparison with the younger patients, had a higher rate of ICH (12.1% versus 5.1%), a higher hospitalization rate (11.7% versus 5.5%), and a higher rate of readmission within 30 days (6.8% versus 3.2%). The elderly population also had longer admission process times (8 h, 25 min, versus 4 h, 09 min) and longer lengths of hospital stay (9 h, 41 min, versus 5 h, 29 min). Of the younger patients, 92% (versus 41% of the elderly population) did not take any drugs, 6% (versus 39%) were receiving antiplatelet therapy, 1% (versus 13%) took vitamin K antagonists, and 1% (versus 7%) took oral direct-acting anticoagulants. Logistic regression models revealed that a 1-year increase in age raised the risk of bleeding by 2% on average; this finding was statistically significant (odds ratio [OR], 1023/year, p < 0.001). The rate of ICH increased significantly after the age of 75, by 180% (OR, 2.82; p < 0.001). ConclusionsThese data suggest that age is an independent risk factor for ICH, whereby the age of 75 entails a 180% increase in the risk of bleeding.

Highlights

We evaluated the risk profile of elderly patients who came to the emergency department for mild head trauma
2851 patients were identified through a search of discharge diagnosis codes corresponding to “cranial trauma,” “intracranial hemorrhage (ICH),” and “skull/face/neck trauma.”
In descending order of frequency, falls (54.71%), accidental collisions (14.90%), minor road accidents (11.93%), syncope (8.05%), violence (5.18%), seizures (0.60%), and sports accidents (0.60%); other causes of trauma were sustained by 4.03% of patients

Summary

Introduction

We evaluated the risk profile of elderly patients who came to the emergency department for mild head trauma. The elderly population had longer admission process times (8 h, 25 min, versus 4 h, 09 min) and longer lengths of hospital stay (9 h, 41 min, versus 5 h, 29 min). Studies report a different distribution regarding the causes of mild head trauma across different world regions, which are not recognizable through such a holistic statement [6, 8, 9]. Some of these had reported that fall is the most common cause of TBI. Older adults with TBI are at greater risk of morbidity and mortality compared to the younger patients [12, 13]

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Discussion

Conclusion