Intracranial Pathology in Elders with Blunt Head Trauma

Abstract

Elder patients with head trauma are at higher risk of developing a significant intracranial injury, including subdural and epidural hematoma. An occult presentation is also more common in elders.

Comparison of Type and Severity of Major Injuries among Undertriaged and Correctly Triaged Older Patients

“…The normality of GCS scores in this study is consistent with findings reported by previous investigators in a study of brain-injured older adults who presented with near-normal GCS scores in the presence of intracranial hemorrhage (10). However, what is inexplicable is that the characteristics of correctly triaged and undertriaged brain-injured patients in this study are similar and do not suggest why some patients were correctly triaged and others were undertriaged.…”

“…The number of injuries among correctly triaged patients ranged from 1 to 38, with a mean of nine injuries per patient (IQR = 6 [6][7][8][9][10][11][12]). Only 3.6% (n = 620) of the undertriaged cohort sustained a single injury that was of AIS 3, 4, or 5 severity, compared to 4.3% (n = 2095) of the correctly triaged cohort.…”

“…A post hoc ordinal correlation of GCS score with mAIS category among brain-injured patients yielded a Kendall's tau-c coefficient = À0.46, p = 0.000, suggesting only a moderate inverse correlation. Among patients whose GCS scores were abnormal (i.e., [3][4][5][6][7][8][9][10][11][12][13][14], most had a GCS = 14 (41.7%). The next largest cluster of GCS scores in this subgroup of brain-injured undertriaged patients was 3 (29.2%).…”

“…Among undertriaged patients, the number of injuries per patient ranged from 1 to 26 (mean = 8, interquartile range [IQR] = 6 [4][5][6][7][8][9][10]). The number of injuries among correctly triaged patients ranged from 1 to 38, with a mean of nine injuries per patient (IQR = 6 [6][7][8][9][10][11][12]).…”

Postoperative outcomes following closed head injury and craniotomy for evacuation of hematoma in patients older than 80 years

“…Because older age is a risk factor for intracranial hemorrhage after head trauma, this question is of increasing importance, as the geriatric population grows in size and the costs and efficacy of end-of-life care continue to be a contentious topic of debate. 7,12,26 An improved understanding of the potential risks of craniotomy for treatment of intracranial hemorrhage in patients over the age of 80 years may allow physicians to make better-informed decisions about treatment options for this population. As there is a paucity of research that has assessed outcomes and morbidity following neurosurgical interventions among these patients relative to younger patients, we assessed the relation between older age and 30-day postoperative outcomes following craniotomy for evacuation of intracranial hemorrhage and hematoma due to closed head trauma.…”