Outcomes in terms of morbidity and mortality among elderly head injury patients on pre-injury anticoagulation: A systematic review protocol

Abstract

Background: The global burden of traumatic brain injuries continues to remain grossly underestimated and is thought to cost about US$400 billion annually. Elderly individuals have the highest age-specific rates of TBIs and are more likely to take anticoagulant medication than other age groups and are therefore theoretically at a higher risk of morbidity and mortality following head injuries. However, the evidence for these worse outcomes is at best unclear, and this has a significant impact on decision-making in clinical settings, sometimes resulting in unnecessary delays to treatment.Methods: This protocol has been developed using the PRISMA-P guidelines. We will search the main clinical indexing databases (including PubMed/MEDLINE, EMBASE, Cochrane reviews, and ClinicalTrials.gov) for studies that evaluated outcomes in terms of morbidity and mortality among anticoagulated individuals aged over 65, to identify all English language studies published between the years 2000 and 2021. The identified studies will then be screened using pre-determined eligibility criteria detailed in the body of this work. Finally, two independent reviewers will screen, select, evaluate the included studies for quality, and extract data related to the use of anticoagulants in the elderly from all relevant sources. A logically sound analytic framework will then be employed to determine the impact of the use of anticoagulation on outcomes as outlined. Discussion: This study aims to identify the existing evidence for outcomes in this population, contribute to the current body of knowledge, and provide more explicit guidance for clinical practice. We envisage that the findings surrounding outcomes in the head-injured, anticoagulated elderly population will guide clinicians towards better decision-making in both the in-patient and out-patient setting and contribute to the development of clinical guidelines. Systematic review registration: This systematic review is registered on the PROSPERO database with registration number: CRD42021220974