Prevalence and Severity of Traumatic Intracranial Hemorrhage in Older Adults with Low‐Energy Falls - American Geriatric Society

BACKGROUND/OBJECTIVES

To determine the prevalence and severity of traumatic intracranial hemorrhage (tICH) in a large cohort of older adults presenting with low‐energy falls and the association with anticoagulation or antiplatelet medication.

DESIGN

Bicentric retrospective cohort analysis.

SETTING

Two level 1 trauma centers in Switzerland and Germany.

PARTICIPANTS

Consecutive sample of older adults (aged ≥65 y) presenting to the emergency department (ED) over a 1‐year period with low‐energy falls who received cranial computed tomography (cCT) within 48 hours of ED presentation.

MEASUREMENTS

The prevalence and severity of tICHs was assessed and the outcomes (in‐hospital mortality, admission to intensive care unit [ICU], or neurosurgical intervention) were specified. We used multivariate regression models to measure the association between anticoagulation/antiplatelet therapy and the risk for tICH after adjustment for known predictors.

RESULTS

The overall prevalence for tICH detected by cCT was 176 of 2567 (6.9%). Neurosurgical intervention was performed in 15 of 176 (8.5%) patients with tICH, 28 of 176 (15.9%) patients were admitted to the ICU, and 14 of 176 (8.0%) died in the hospital. CT‐detected skull fracture and signs of injury above the clavicles were the strongest predictors for the presence of tICH (odds ratio [OR] = 4.28; 95% confidence interval [CI] = 2.79‐6.51; OR = 1.88; 95% CI = 1.3‐2.73, respectively). Among 2567 included patients, 1424 (55%) were on anticoagulation/antiplatelet therapy. Multivariate regression models showed no differences for the risk of tICH (OR = 1.05; 95% CI = .76‐1.47; P = .76) or association with the head‐specific Injury Severity Scale (incident rate ratio = 1.08; 95% CI = .97‐1.19; P = .15) with or without anticoagulation/antiplatelet therapy.

CONCLUSION

Medication with anticoagulants or antiplatelet agents was not associated with higher prevalence and severity of tICH in older patients with low‐energy falls undergoing cCT examination. In addition to cCT‐detected skull fractures, visible injuries above the clavicles were the strongest clinical predictors for tICH. Our findings merit prospective validation.

from Wiley: Journal of the American Geriatrics Society: Table of Contents https://ift.tt/32VFdUo
via IFTTT