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Prevalence and Severity of Traumatic Intracranial Hemorrhage in Older Adults with Low‐Energy Falls

2020; Wiley; Volume: 68; Issue: 5 Linguagem: Inglês

10.1111/jgs.16400

1532-5415

Alina Lampart, Tobias Kuster, Christian H. Nickel, Roland Bingisser, Vera Pedersen,

Trauma and Emergency Care Studies

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. J Am Geriatr Soc 68:977–982, 2020