Ground falls most common cause of head injury in elderly, new study finds

Falls are the most typical explanation for damage amongst adults 65 and older in america. In response to the U.S. Facilities for Illness Management and Prevention, yearly, greater than 14 million older adults (one in 4) report a fall. About 90% of head accidents amongst older people is because of ground-level falls.

Evaluating an older grownup with a head damage within the emergency division (ED) requires cautious evaluation as a result of elevated danger of problems akin to intracranial hemorrhage. There is also heightened concern for older sufferers taking anticoagulants or blood thinners who maintain a head damage due to the chance of delayed intracranial hemorrhage (ICH).

ICH is a sort of traumatic intracranial hemorrhage that takes place in numerous areas of the mind. A delayed ICH can happen as much as a number of weeks after the damage, however often inside 48 hours. As such, this danger has prompted some suppliers to confess these sufferers to the hospital for commentary and repeat CT scans, the imaging modality of selection for evaluating acute head accidents. 

Earlier experiences have steered charges as excessive as 7.2% for delayed ICH in older adults on anticoagulants who maintain a head damage, sparking debate over administration practices. Presently, the necessity for commentary and routine follow-up diagnostic CT scans stays controversial.

Now, a brand new examine by researchers at Florida Atlantic College’s Schmidt Faculty of Medication challenges earlier greater estimates of delayed ICH incidence on this affected person inhabitants and offers vital information to tell scientific follow within the ED. 

Researchers carried out a potential cohort examine aimed to evaluate the precise incidence of delayed ICH in geriatric ED sufferers on anticoagulants, evaluating it throughout various kinds of anticoagulant drugs. Examine topics had been positioned into 4 teams by anticoagulant use: no anticoagulant use; Warfarin; direct oral anticoagulant (included dabigatran, rivaroxaban and apixaban); and Heparinoid (included heparin and enoxaparin).

Outcomes of the examine, printed in The Journal of Emergency Medication, present that out of three,425 sufferers enrolled within the examine, 0.4% (13 sufferers) skilled a delayed ICH, a considerably decrease charge than beforehand reported. There have been no variations in charges of delayed ICH between those that had been prescribed anticoagulants versus those that had not.

These findings recommend that geriatric head trauma sufferers within the ED taking Warfarin or different anticoagulants previous to their damage don’t should be admitted to the hospital for 24-hour commentary and don’t require routine repeat CT scans.

If anticoagulated head trauma sufferers had this comparatively excessive frequency of delayed intracranial hemorrhages beforehand reported, then routine repeat head CT scans in all instances at 24 hours would require a considerable change in present follow in emergency departments. Due to this controversial situation, our goal was to carry out a bigger potential examine to validate or refute these findings.”

Richard Shih, M.D., Senior Writer and Professor, Emergency Medication, Schmidt Faculty of Medication, Florida Atlantic College

The examine was carried out at two hospitals from August 2019 to July 2020, in 3,425 sufferers aged 65 years or older with acute head damage. Comply with-up included phone calls and chart opinions to detect delayed ICH.

Among the many 3,425 sufferers included within the evaluation, the most typical mechanism of damage in all teams was a ground-level fall (77.9% of all instances). A motorcar accident (6.2%) was the following commonest with all others causes representing lower than 7% of instances.

“Our examine offers vital information for clinicians managing older sufferers on anticoagulants who current with head trauma, probably influencing tips and practices concerning commentary and imaging protocols,” mentioned Shih.

Examine co-authors are Scott M. Alter, M.D., an affiliate professor of emergency drugs and assistant dean for scientific analysis; Joshua J. Solano, M.D., an affiliate professor of emergency drugs and clerkship director; Gabriella Engstrom, Ph.D., senior undertaking coordinator; Mike Wells, Ph.D., analysis assistant professor, Division of Emergency Medication; Lisa Clayton, D.O., chair, Division of Emergency Medication, an affiliate professor, assistant dean for graduate medical training and program director, emergency drugs residency; Patrick G. Hughes, D.O., an emergency drugs doctor; Lara Nicole Goldstein, M.D., Ph.D., an emergency drugs doctor; Faris Okay. Azar, M.D., a normal surgeon; and Joseph G. Ouslander, M.D., a professor of geriatric drugs, all inside the FAU Schmidt Faculty of Medication.

The analysis was supported by The Florida Medical Malpractice Joint Underwriting Affiliation Grant for Security of Well being Care Providers awarded to Shih (Grant RFA #2018-01).

“This undertaking would by no means have occurred with out the assist of The Florida Medical Malpractice Joint Underwriting Affiliation, whose fundamental purpose is to enhance affected person security in Florida,” mentioned Shih. “Provided that so a lot of our older residents are on anticoagulants and infrequently fall and injure their heads, this diagnostic situation is a vital one for physicians treating these sufferers within the emergency division.”