Head injury in the elderly – an overview for the physician

Beedham, William; Peck, George; Richardson, Simon; Tsang, Kevin; Fertleman, Michael; Shipway, David Jh

doi:10.7861/clinmedicine.19-2-177

Cited by 18 publications

(11 citation statements)

References 48 publications

(50 reference statements)

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“…Our results correspond to the findings of Beedham et al, who described that frail, older patients often sustain head injury when they fall and are predisposed to hemorrhagic complications because of anticoagulant use and the effects of ageing [ 23 ]. As falling itself is associated with frailty [ 24 ] and especially seniors in a poorer health state are most likely to fall and therefore may have a higher risk of intracranial bleedings [ 25 ], the use of OAC/PAI in these patients is dangerous, although it may be necessary.…”

Section: Discussionsupporting

confidence: 92%

Influence of Oral Anticoagulation and Antiplatelet Drugs on Outcome of Elderly Severely Injured Patients

Kerschbaum

Henssler

Ernstberger

et al. 2021

JCM

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Introduction: Severely injured elderly patients have a poorer prognosis and higher mortality rates after severe trauma compared with younger patients. The aim of this study was to correlate the influence of pre-existing oral anticoagulation (OAC) and antiplatelet drugs (PAI) on the outcome of severely injured elderly patients. Methods: Using a prospective cohort study model over an 11-year period, severely injured elderly patients (≥65 years and ISS ≥ 16) were divided into two groups (no anticoagulation/platelet inhibitors: nAP and OAC/PAI). A comparison of the groups was conducted regarding injury frequency, trauma mechanism, severity of head injuries, and medication-related mortality. Results: In total, 254 out of 301 patients were analyzed (nAP: n = 145; OAC/PAI: n = 109, unknown data: n = 47). The most relevant injury was falling from low heights (<3 m), which led to a significantly higher number of severe injuries in patients with OAC/PAI. Patients with pre-existing OAC/PAI showed a significantly higher overall mortality rate compared to the group without (38.5% vs. 24.8%; p = 0.019). The severity of head injuries in OAC/PAI was also higher on average (AIS 3.7 ± 1.6 vs. 2.8 ± 1.9; p = 0.000). Conclusion: Pre-existing oral anticoagulation and/or platelet aggregation inhibitors are related to a higher mortality rate in elderly polytrauma patients. Low-energy trauma can lead to even more severe head injuries due to pre-existing medication than is already the case in elderly patients without OAC/PAI.

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Section: Discussionsupporting

confidence: 92%

Influence of Oral Anticoagulation and Antiplatelet Drugs on Outcome of Elderly Severely Injured Patients

Kerschbaum

Henssler

Ernstberger

et al. 2021

JCM

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“…They include that over 10% 10,12 will have acute trauma‐related findings, deterioration can be sudden and delayed, and that up to 20% in some series undergo neurosurgical intervention 10,12,17 . Most research, however, pertains to the community‐dwelling elderly, rather than to RACF residents who are both generally frailer and more prone to falls 4–6 . Our acute intracranial trauma‐related pathology rate of 6% is consistent with that for the general elderly population, but our neurosurgical intervention rate was zero.…”

Section: Discussionmentioning

confidence: 99%

“…While falls in the elderly lead to a range of injuries, 4 intracranial trauma is acknowledged to be one of the most serious contributors to morbidity and mortality 6 . Post‐fall, up to 26% of silver trauma patients have acute trauma‐related findings on CT of the brain (CTB), with over 2% requiring neurosurgical intervention 7–12 .…”

Section: Introductionmentioning

confidence: 99%

“…While falls in the elderly lead to a range of injuries, 4 intracranial trauma is acknowledged to be one of the most serious contributors to morbidity and mortality. 6 Post‐fall, up to 26% of silver trauma patients have acute trauma‐related findings on CT of the brain (CTB), with over 2% requiring neurosurgical intervention. 7 , 8 , 9 , 10 , 11 , 12 For this reason, expert consensus guidelines and coronial recommendations support hospital assessment with CTB for elderly people with potential intracranial injury following a fall.…”

Section: Introductionmentioning

confidence: 99%

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Potentially avoidable emergency department transfers from residential aged care facilities for possible post‐fall intracranial injury

Tulchinsky

Buckley

Meek

et al. 2022

Emerg Medicine Australasia

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Objectives To determine the percentage of potentially preventable residential aged care facility (RACF) to ED transfers for potential intracranial injury post‐fall. To describe rates of CT brain (CTB) performance, intracranial trauma‐related findings, neurosurgical intervention, and patient outcome. Methods Patient lists were obtained from the hospital electronic medical record, screened for eligibility and data abstracted. Potentially preventable was defined as: (1) RACF return from ED within 24 h, regardless of CTB performance or finding; (2) ED management could reasonably have been provided at the RACF. Comparisons between those with CTB performed or not, including external signs of craniofacial trauma, anticoagulant medication use, baseline cognitive impairment and presence of an advanced care directive (ACD) were made. Results Of 784 patients, 415 (53%) were classified as potentially avoidable. Of these, 314 (76%) had a CTB. Of all 784 patients, 538 (69%) had a CTB performed. CTB was more likely with presence of external signs of craniofacial trauma (26% [95% CI 23–30] vs 20% [95% CI 15–25], P < 0.001) and anticoagulant use (59% [95% CI 55–63] vs 42% [95% CI 37–49], P < 0.001) but not for presence of cognitive impairment or ACD. From the 538 CTBs, 31 (6%) patients had acute intracranial trauma‐related findings with all having conservative management. None of the 11 (1%) deaths were in the potentially preventable subgroup. Conclusion Just over half of the RACF to ED transfers were classified as ‘potentially avoidable’.

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“…In a recent study, Beedham et al described that frail, older patients often sustain head injury when they fall and are predisposed to hemorrhagic complications because of anticoagulant use and the effects of aging [ 22 ]. This is in accordance with the findings of Karibe et al, who found falling to be one of the most common reasons for traumatic brain injury, caused by degraded motoric and physiological functions [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Are There Any Red Flag Injuries in Severely Injured Patients in Older Age?

Popp

Frankewycz

Lang

et al. 2021

JCM

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Introduction: Severely injured elderly patients pose a significant burden to trauma centers and, compared with younger patients, have worse prognoses and higher mortality rates after major trauma. The objective of this study was to identify the etiological mechanisms that are associated with severe trauma in elderly patients and to detect which injuries correlate with high mortality in elderly patients. Methods: Using a prospect cohort study model over an 11-year period, severely injured patients (ISS ≥ 16) were divided into two age groups (Group 1: 18–64; Group 2: 65–99 years). A comparison of the groups was conducted regarding injury frequency, trauma mechanism, distribution of affected body parts (AIS and ISS regions) and injury related mortality. Results: In total, 1008 patient were included (Group 1: n = 771; Group 2: n = 237). The most relevant injury in elderly patients was falling from low heights (<3 m) in contrast to traffic accident in young patients. Severely injured patients in the older age group showed a significantly higher overall mortality rate compared to the younger group (37.6% vs. 11.7%; p = 0.000). In both groups, the 30-day survival for patients without head injuries was significantly better compared to patients with head injuries (92.7% vs. 85.3%; p = 0.017), especially analyzing elderly patients (86.6% vs. 58.6%; p = 0.003). The relative risk of 30-day mortality in patients who suffered a head injury was also higher in the elderly group (OR: Group 1: 4.905; Group 2: 7.132). Conclusion: In contrast to younger patients, falls from low heights (<3 m) are significant risk factors for severe injuries in the geriatric collective. Additionally, elderly patients with an ISS ≥ 16 had a significantly higher mortality rate compared to severe injured younger patients. Head injuries, even minor head traumata, are associated with a significant increase in mortality. These findings will contribute to the development of more age-related therapy strategies in severely injured patients.

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Head injury in the elderly – an overview for the physician

Cited by 18 publications

References 48 publications

Influence of Oral Anticoagulation and Antiplatelet Drugs on Outcome of Elderly Severely Injured Patients

Influence of Oral Anticoagulation and Antiplatelet Drugs on Outcome of Elderly Severely Injured Patients

Potentially avoidable emergency department transfers from residential aged care facilities for possible post‐fall intracranial injury

Are There Any Red Flag Injuries in Severely Injured Patients in Older Age?

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