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

Authors

  • Anupama S. Gangavati MD,

    1. From the *Department of Medicine, Division of Gerontology, and §Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts.
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  • Dan K. Kiely MPH, MA,

    1. From the *Department of Medicine, Division of Gerontology, and §Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts.
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  • Lara K. Kulchycki MD,

    1. From the *Department of Medicine, Division of Gerontology, and §Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts.
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  • Richard E. Wolfe MD,

    1. From the *Department of Medicine, Division of Gerontology, and §Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts.
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  • J. Lawrence Mottley MD,

    1. From the *Department of Medicine, Division of Gerontology, and §Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts.
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  • Sean P. Kelly MD, MPH,

    1. From the *Department of Medicine, Division of Gerontology, and §Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts.
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  • Larry A. Nathanson MD,

    1. From the *Department of Medicine, Division of Gerontology, and §Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts.
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  • Alan P. Abrams MD, MPH,

    1. From the *Department of Medicine, Division of Gerontology, and §Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts.
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  • Lewis A. Lipsitz MD

    1. From the *Department of Medicine, Division of Gerontology, and §Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts.
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Address correspondence to Anupama S. Gangavati, Instructor of Medicine, Harvard Medical School, Division of Gerontology, Beth Israel Deaconess Medical Center, 110 Francis Street, LMOB 1A, Boston, MA 02215. E-mail: agangava@bidmc.harvard.edu

Abstract

OBJECTIVES: To determine the prevalence and associated characteristics of traumatic intracranial hemorrhage (ICH) in elderly fallers presenting to the emergency department (ED) without focal findings.

DESIGN: Retrospective cohort study.

SETTING: University-affiliated teaching hospital ED.

PARTICIPANTS: Patients aged 65 and older presenting with a fall to the ED and undergoing a head computed tomography (CT) scan.

MEASUREMENTS: Electronic medical records and CT scans of 404 consecutive patients were reviewed. Characteristics of patients with and without ICH were compared using unadjusted analyses. Patients taking warfarin, aspirin, or clopidogrel alone or in combination were compared with those not taking these medications. Multivariate logistic regression analyses were performed to determine variables independently associated with ICH.

RESULTS: Forty-seven of 404 elderly fallers (11.6%) without focal findings had an ICH. Unadjusted analyses in these pilot data showed that warfarin was not significantly associated with ICH. Multivariate analyses indicated that elderly people living in at home were more likely to have ICH than those living in nursing homes or assisted living facilities (odds ratio (OR)=3.2, 95% confidence interval (CI)=1.30–8.13) and that those with head trauma were more likely to have ICH than those without (OR=3.9, 95% CI=1.25–7.80). Aspirin was found to be protective (OR=0.49, 95% CI=0.24–0.98).

CONCLUSION: 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.

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