Mild head trauma in elderly patients: experience of an emergency department

Abstract

Introduction We evaluated the risk profile of elderly patients who came to the emergency department for mild head trauma. The primary goal was to determine the difference in the incidence of posttraumatic intracranial hemorrhage (ICH) after minor head injury (MHI). The secondary objective was to assess worse outcome, such as: hospitalization rate, rate of re-admission, need of neurosurgery. We also assess the admission process times and length of hospital stay. The ultimate goal was to optimize the diagnostic-observational management of minor head trauma in elderly patients. Material and methods We evaluated all patients with MHI who came to our emergency department during 2017 and 2018. All patients underwent computed tomography. Results We enrolled 2325 patients, of whom 1094 were 75 years of age or older. The population was divided into two categories according to age: The “elderly population” was 75 or older, and the younger patients were younger than 75. The elderly population, in comparison with the younger patients, had a higher rate of ICH (12.1% versus 5.1%), a higher hospitalization rate (11.7% versus 5.5%), and a higher rate of readmission within 30 days (6.8% versus 3.2%). The elderly population also had longer admission process times (8 h, 25 min, versus 4 h, 09 min) and longer lengths of hospital stay (9 h, 41 min, versus 5 h, 29 min). Of the younger patients, 92% (versus 41% of the elderly population) did not take any drugs, 6% (versus 39%) were receiving antiplatelet therapy, 1% (versus 13%) took vitamin K antagonists, and 1% (versus 7%) took oral direct-acting anticoagulants. Logistic regression models revealed that a 1-year increase in age raised the risk of bleeding by 2% on average; this finding was statistically significant (odds ratio [OR], 1023/year, p < 0.001). The rate of ICH increased significantly after the age of 75, by 180% (OR, 2.82; p < 0.001). Conclusions These data suggest that age is an independent risk factor for ICH, whereby the age of 75 entails a 180% increase in the risk of bleeding.

Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists

“…Recent studies have increasingly focused on the lasting effects of MHI and observed that chronic diseases were associated with post-discharge mortality after MHI. It has been argued that its effect on older patients could be partly explained by pre-existing comorbidities [ 50 , 52 , 55 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 ]. It may be interesting for future studies to assess the possible impact of anticoagulant drugs on long-term mortality, and also the effects that DOACs may have on the overall outcome of emergency and elective neurosurgical pathologies, as raised by our group [ 48 , 53 , 58 , 91 , 92 , 93 , 94 , 95 ].…”

Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

“…Regarding the changes of fibrinolysis inhibitors, few cases have been reported. Concerning platelet function, patients with TBI appear to have moderately low counts, but often, they are activated, permitting pro-coagulant activity [ 25 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 ].…”

“…In addition to the aforementioned factors, the severity of coagulation disorders is influenced by environmental factors and the resulting therapeutic factors such as the genetic background, inflammation, and premedication, especially with oral anticoagulant use [ 101 , 102 , 103 ]. Concerning the involvement of anatomical regions, associations were found between TIC and the involvement of the abdominal region [ 93 , 101 , 102 , 103 ]. A recent study reported that a higher number of involved regions was correlated with the early development of TIC [ 93 ].…”

“…Concerning the involvement of anatomical regions, associations were found between TIC and the involvement of the abdominal region [ 93 , 101 , 102 , 103 ]. A recent study reported that a higher number of involved regions was correlated with the early development of TIC [ 93 ]. Some authors have highlighted the role of some biomarkers, in particular troponin and ultra-sensitive troponin, in highlighting worse outcomes, also due to bleeding, of trauma patients.…”

Mild Head Trauma: Is Antiplatelet Therapy a Risk Factor for Hemorrhagic Complications?

“…The tendency to bleed is more pronounced with age [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Since 2015, antiplatelets have increasingly been used as the primary method of preventing cardiovascular diseases [ 20 , 21 , 22 , 23 ].…”