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

Lampart, Alina; Kuster, Tobias; Nickel, Christian H.; Bingisser, Roland und Pedersen, Vera (2020): Prevalence and Severity of Traumatic Intracranial Hemorrhage in Older Adults with Low-Energy Falls. In: Journal of the American Geriatrics Society, Bd. 68, Nr. 5: S. 977-982

Abstract

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

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0002-8614
• Sprache: Englisch