TY - JOUR
T1 - Mild head trauma in elderly patients
T2 - experience of an emergency department
AU - Savioli, Gabriele
AU - Ceresa, Iride Francesca
AU - Ciceri, Luca
AU - Sciutti, Fabio
AU - Belliato, Mirko
AU - Iotti, Giorgio Antonio
AU - Luzzi, Sabino
AU - Del Maestro, Mattia
AU - Mezzini, Gianluca
AU - Lafe, Elvis
AU - Simoncelli, Anna
AU - Ricevuti, Giovanni
AU - Manzoni, Federica
AU - Bressan, Maria Antonietta
PY - 2020/7
Y1 - 2020/7
N2 - 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.
AB - 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.
KW - Brain injury management
KW - Clinical research
KW - Elderly patients
KW - Emergency medicine
KW - Hemorrhage
KW - Internal medicine
KW - Mild traumatic brain injury
KW - Neurosurgery
KW - Posttraumatic intracranial hemorrhage
KW - Trauma
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U2 - 10.1016/j.heliyon.2020.e04226
DO - 10.1016/j.heliyon.2020.e04226
M3 - Article
AN - SCOPUS:85087513309
VL - 6
JO - Heliyon
JF - Heliyon
SN - 2405-8440
IS - 7
M1 - e04226
ER -