Prevalence and Characteristics of Traumatic Intracranial Hemorrhage in Elderly Fallers Presenting to the Emergency Department without Focal Findings

Gangavati, Anupama S.; Kiely, Dan K.; Kulchycki, Lara K.; Wolfe, Richard E.; Mottley, J. Lawrence; Kelly, Sean P.; Nathanson, Larry; Abrams, Alan; Lipsitz, Lewis A.

doi:10.1111/j.1532-5415.2009.02344.x

Cited by 32 publications

(50 citation statements)

References 23 publications

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“…Nevertheless, the preinjury intake of alcohol may not be associated with unfavorable outcomes, which is compatible with previous reports. 5) The presence of skull fracture, mean GCS score, MLS AE5 mm, surgical intervention, and the use of blood-derived products were not significantly different between the 3 groups ( Table 1). Figure 1 demonstrated a significant increase in the frequency of unfavorable outcomes with advancing age by the Cochrane-Armitage test, which checks for trend in binomial proportions across levels of a single factor or covariate.…”

Section: Discussionmentioning

confidence: 93%

“…Warfarin is known to have unfavorable effects, but whether the use of AP agents is associated with unfavorable outcomes remains controversial. [2][3][4][5][6]12,13) Therefore, the adverse effects of AP and AC agents must be evaluated separately in future studies. We combined AP and AC agents mainly because of the small number of patients in each age group.…”

Section: Discussionmentioning

confidence: 99%

“…1,8,11,12,17) Currently, the chronological age of 65 years or older is defined as``elderly'' according to the Ministry of Health, Labour and Welfare. 10) Many clinical studies of geriatric TICH have regarded patients aged AE65 years as a single homogeneous group, 2,5,6) and few studies have considered the possible heterogeneity within the population. 4,11,12) However, the demographic characteristics as well as clinical outcomes are likely to differ substantially between hexagenarians and octogenarians after fallrelated TICH.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, preinjury medication with anti-platelet/anti-coagulant (AP/AC) agents, which are commonly prescribed to treat or prevent cerebro-and cardiovascular diseases, may be associated with unfavorable outcomes in elderly patients with TICH. [2][3][4][5][6]9) The present study divided elderly patients with fall-related TICH into 3 age groups according to the Centers for Disease Control and Prevention (CDC) classification, 1) and evaluated intergroup differences in the demographics and outcomes at discharge, as well as investigating whether the use of AP/AC agents was associated with unfavorable outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Age and Anti-platelet/Anti-coagulant Use on the Outcome of Elderly Patients With Fall-Related Traumatic Intracranial Hemorrhage

Inamasu

Nakatsukasa

Kuramae

et al. 2010

Neurol. Med. Chir.(Tokyo)

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Ground-level fall is the most common cause of traumatic intracranial hemorrhage (TICH) in the elderly. Many studies on geriatric TICH have regarded patients aged AE65 years as a single group, but substantial heterogeneity is likely to exist within this population. Eighty-two elderly patients with fall-related TICH treated in our institution during a 6-year period were stratified into 3 age groups (65-74, 75-84, and AE85 years), and intergroup differences in the demographics and outcomes at discharge were evaluated. The influence of the use of anti-platelet/anti-coagulant (AP/AC) agent on outcomes was also investigated. Comparison of demographic variables demonstrated significant differences in the frequency of preinjury alcohol consumption and use of AP/AC agents between the 3 groups, indicating that the causes or triggers of fall might be substantially different between the 65-74 years group and the other two groups combined. The frequency of unfavorable outcomes increased with age, and the increase was statistically significant. The 82 patients were divided into two subgroups depending on the use of AP/AC agents. The outcomes of the AE85 years group taking AP/AC agents were particularly poor compared with those of the AE85 years group not using AP/AC agents. Advancing age may be associated with unfavorable outcomes in elderly patients with fall-related TICH, and patients aged AE85 years taking AP/AC have the greatest risk of unfavorable outcomes. Physicians must consider the risk/benefit analysis before prescribing AP/AC agents to patients aged AE85 years.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Influence of Age and Anti-platelet/Anti-coagulant Use on the Outcome of Elderly Patients With Fall-Related Traumatic Intracranial Hemorrhage

Inamasu

Nakatsukasa

Kuramae

et al. 2010

Neurol. Med. Chir.(Tokyo)

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“…Although urinary incontinence and gait disturbance did not feature among the characteristics of 47 patients with intracranial hemorrhage, 32 of whom had subdural hematoma (SDH), 1 even in the absence of lateralizing signs, identification of the triad of intellectual deterioration, new-onset urinary incontinence, and gait disturbance can aid diagnosis of bilateral subdural hematoma. 2 In the latter study, of 10 subjects with bilateral subdural hematoma, six were aged 46 to 77, with concurrent urinary incontinence associated with mild headache and intellectual deterioration.…”

mentioning

confidence: 99%

Urinary Incontinence May Be a Feature of Bilateral Subdural Hemorrhage in Patients Who Have No Lateralizing Signs

Jolobe¹

2010

J American Geriatrics Society

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Deciphering glycomics and neuroproteomic alterations in experimental traumatic brain injury: Comparative analysis of aspirin and clopidogrel treatment

et al. 2016

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As populations age, the number of patients sustaining traumatic brain injury (TBI) and concomitantly receiving preinjury antiplatelet therapy such as aspirin (ASA) and clopidogrel (CLOP) is rising. These drugs have been linked with unfavorable clinical outcomes following TBI, where the exact mechanism(s) involved are still unknown. In this novel work, we aimed to identify and compare the altered proteome profile imposed by ASA and CLOP when administered alone or in combination, prior to experimental TBI. Furthermore, we assessed differential glycosylation PTM patterns following experimental controlled cortical impact model of TBI, ASA, CLOP, and ASA + CLOP. Ipsilateral cortical brain tissues were harvested 48 h postinjury and were analyzed using an advanced neuroproteomics LC-MS/MS platform to assess proteomic and glycoproteins alterations. Of interest, differential proteins pertaining to each group (22 in TBI, 41 in TBI + ASA, 44 in TBI + CLOP, and 34 in TBI + ASA + CLOP) were revealed. Advanced bioinformatics/systems biology and clustering analyses were performed to evaluate biological networks and protein interaction maps illustrating molecular pathways involved in the experimental conditions. Results have indicated that proteins involved in neuroprotective cellular pathways were upregulated in the ASA and CLOP groups when given separately. However, ASA + CLOP administration revealed enrichment in biological pathways relevant to inflammation and proinjury mechanisms. Moreover, results showed differential upregulation of glycoproteins levels in the sialylated N-glycans PTMs that can be implicated in pathological changes. Omics data obtained have provided molecular insights of the underlying mechanisms that can be translated into clinical bedside settings.

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Prevalence and Characteristics of Traumatic Intracranial Hemorrhage in Elderly Fallers Presenting to the Emergency Department without Focal Findings

Abstract: ICH is common in elderly fallers presenting to the ED without focal findings. Anticoagulation alone did not appear to increase the risk of ICH, and aspirin was found to be protective, but prospective studies are needed to better assess this relationship.

Cited by 32 publications

References 23 publications

Influence of Age and Anti-platelet/Anti-coagulant Use on the Outcome of Elderly Patients With Fall-Related Traumatic Intracranial Hemorrhage

Influence of Age and Anti-platelet/Anti-coagulant Use on the Outcome of Elderly Patients With Fall-Related Traumatic Intracranial Hemorrhage

Urinary Incontinence May Be a Feature of Bilateral Subdural Hemorrhage in Patients Who Have No Lateralizing Signs

Deciphering glycomics and neuroproteomic alterations in experimental traumatic brain injury: Comparative analysis of aspirin and clopidogrel treatment

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