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Keywords:

  • geriatrics;
  • aged;
  • accidents;
  • neurosurgery;
  • head injuries;
  • closed;
  • trauma

Abstract

  1. Top of page
  2. Abstract
  3. References

Abstract. Objective: Little is known about the circumstances surrounding closed head trauma (CHT) in elders, and how they differ from nonelders. The study objective was to compare the 2 populations for outcome (positive cranial CT scan depicting traumatic injury, or the need for neurosurgery), mechanism of injury, and the value of the neurologic examination to predict a CT scan positive for traumatic injury or the need for neurosurgical intervention. Methods: A retrospective study was conducted by collecting a case series of patients with blunt head trauma who underwent CT scanning, and comparing elder (aged s60 years) with nonelder patients. The setting was the ED of a university-affiliated Level-1 trauma center. Results: Twenty percent of the elders and 13% of the nonelders had CT scans positive for traumatic injury, which conferred a risk ratio of 1.58 (95% CI 1.21–2.05). Older women were more at risk for the need for neurosurgery than were younger ones (3.1 vs 0.3%, RR 10.66, 95% CI 1.26–90.46). Among the elders, falls were the dominant mechanism of closed head trauma, followed by motor vehicle collisions (MVCs), then being struck as a pedestrian. In the nonelders, MVCs, falls, and assaults were the most important mechanisms of injury. A focally abnormal neurologic examination imparted an increased risk for both a CT scan positive for traumatic injury (elder 4.39, 95% CI 2.91–6.62; nonelder 7.75, 95% CI 5.53–10.72) and the need for neurosurgery (elder 35.68, 95% CI 4.58–275.89; nonelder 142.58, 95% CI 19.11–1064.22) in both age groups. Conclusions: Significant differences exist between elder and nonelder victims of CHT with respect to mechanisms of trauma and outcomes (CT scan positive for traumatic injury, or the need for neurosurgery).

References

  1. Top of page
  2. Abstract
  3. References
  • 1
    Baker SP, O'Neill B, Ginsberg MJ, Li G. The Injury Fact Book, 2nd ed. New York : Oxford University Press, 1992.
  • 2
    Fife D, Barancik JI, Chatterjee BF. Northeastern Ohio trauma study:II. Injury rates by age, sex, and cause. Am J Public Health. 1984;74:4738.
  • 3
    Spaite DW, Criss EA, Valenzuela TD, Meislin HW, Ross J. Geriatric injury:an analysis of prehospital demographics, mechanisms, and patterns. Ann Emerg Med. 1990;19:141820.
  • 4
    Kraus JF, Black MA, Hessol N, et al. The incidence of acute brain injury and serious impairment in a defined population. Am J Epidemiol. 1984;119:186201.
  • 5
    Masters SJ, McClean PM, Arcarese JS, et al. Skull x-ray examination after head trauma. Recommendations by a mul-tidisciplinary panel and validation study. N Engl J Med. 1987;316:8491.
  • 6
    West JG, Eastman AB. Field triage. In: MattoxKL, MooreEE, FelicianoDV (eds). Trauma. Norwalk , CT : Appleton and Lange, 1988.
  • 7
    Mosenthal AC, Livingston DH, Elcavage J, Merritt S, Stucker S. Falls:epidemiology and strategies for prevention. J Trauma. 1995;38:7536.
  • 8
    Jeret JS, Mandell M, Anziske B, et al. Clinical predictors of abnormality disclosed by computed tomography after mild head trauma. Neurosurgery. 1993;32:915.
  • 9
    Roy CW, Pentland B, Miller JP. The causes and consequences of minor head injury in the elderly. Injury. 1986;17:2203.
  • 10
    Kraus JF, Morgenstern H, Fife D, Conroy C, Nourjah P. Blood alcohol tests, prevalence of involvement, and outcome following brain injury. Am J Public Health. 1989;79:2949.
  • 11
    Rivara FP, Jurkovich GJ, Gurney JG, et al. The magnitude of acute and chronic alcohol abuse in trauma patients. Arch Surg. 1993;128:90713.
  • 12
    Jagger J, Fife D, Vernberg K, Jane JA. Effect of alcohol intoxication on the diagnosis and apparent severity of brain injury. Neurosurgery. 1984;3:3036.
  • 13
    Shackford SR, Wald SL, Ross SE, et al. The clinical utility of computed tomographic scanning and neurologic examination in the management of patients with minor head injuries. J Trauma. 1992;33:38594.
  • 14
    Pories SE, Gamelli RL, Vacek P, Goodwin G, Shinozaki T, Harris F. Intoxication and injury. J Trauma. 1992;32:604.
  • 15
    Madden C, Witzke DB, Sanders AB, Valente J, Fritz M. High-yield selection criteria for cranial computed tomography after acute trauma. Acad Emerg Med. 1995;2:24853.
  • 16
    Harad FT, Kerstein MD. Inadequacy of bedside clinical indicators in identifying significant intracranial injury in trauma patients. J Trauma. 1992;32:35963.
  • 17
    Miller JD, Murray LS, Teasdale GM. Development of a Traumatic intracranial hematoma after “minor” head injury. Neurosurgery. 1990;27:66973.