Abstract
Background: We aimed to explore the risk factors that contribute to the mortality of elderly trauma patients with acute subdural hematoma (SDH) resulting from a fall. Mortality rates of the elderly were compared to those of young adults. Methods: A total of 444 patients with acute traumatic subdural hematoma resulting from a fall, admitted to a level I trauma center from 1 January 2009 to 31 December 2016 were enrolled in this study. Patients were categorized into two groups: elderly patients (n = 279) and young adults (n = 165). The primary outcome of this study was patient mortality in hospital. The adjusted odds ratio (AOR) with 95% confidence interval (CI) for mortality was calculated according to gender and pre-existing comorbidities. Univariate and multivariate logistic regression analyses were performed to identify factors related to mortality in the elderly. Results: The odds ratio for mortality caused by falls in the elderly patients was four-fold higher than in the young adults, after adjusting for gender and pre-existing comorbidities. In addition, the presence of pre-existing coronary artery disease (OR 3.2, 95% CI 1.09–9.69, p = 0.035), end-stage renal disease (OR 4.6, 95% CI 1.48–14.13, p = 0.008), hematoma volume (OR 1.2, 95% CI 1.11–1.36, p < 0.001), injury severity score (OR 1.3, 95% CI 1.23–1.46, p < 0.001), and coagulopathy (OR 4.0, 95% CI 1.47–11.05, p = 0.007) were significant independent risk factors for mortality in patients with acute traumatic SDH resulting from a fall. Conclusions: In this study, we identified that pre-existing CAD, ESRD, hematoma volume, ISS, and coagulopathy were significant independent risk factors for mortality in patients with acute traumatic SDH. These results suggest that death following acute SDH is influenced both by the extent of neurological damage and the overall health of the patient at the time of injury.
Highlights
There has been a worldwide increase in the incidence of fall related injuries, in part caused by the increasing elderly population
The prevalence of pre-existing comorbidities including diabetes mellitus (DM), HTN, coronary artery disease (CAD), cerebral vascular accident (CVA), and end-stage renal disease (ESRD) was significantly higher in elderly patients than in young adults
The elderly patients did not have a significantly higher Glasgow Coma Score (GCS) score than the young adults, nor was there a greater percentage of elderly patients with a GCS score of ≤8, a GCS score between 9 and 12, or a GCS score ≥ 13 compared to younger patients
Summary
There has been a worldwide increase in the incidence of fall related injuries, in part caused by the increasing elderly population. Falls are the leading cause of hospital admission for traumatic injury in elderly patients [1]. It has been reported that falls are the most common cause of acute subdural hematoma (SDH) [1,2,3]. Of 92,030 patients with SDH in the National Trauma Data Bank in the United States, 55,729 (61%) had sustained injuries from falling [4]. Previous studies have revealed an association between the risk of SDH and falls [4]. We aimed to explore the risk factors that contribute to the mortality of elderly trauma patients with acute subdural hematoma (SDH) resulting from a fall. Methods: A total of 444 patients with acute traumatic subdural hematoma resulting from a fall, admitted to a level I trauma center from 1 January 2009 to. Univariate and multivariate logistic regression analyses were performed to identify factors related to mortality in the elderly
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