Head Trauma in Elderly Patients: Mechanisms of Injuries and CT Findings.

BACKGROUND: Head injuries in elderly people are a common cause of hospitalization at emergency departments. This group of patients is at high risk of post-traumatic intracranial pathology, which is diagnosed by computed tomography (CT) scanning of the head.

OBJECTIVES: The aim of this study was to determine the incidence and outcomes of head trauma in older people in different scenarios, on the basis of CT scan findings.

MATERIAL AND METHODS: The study involved a retrospective analysis of medical records of patients treated in the Emergency Department of Copernicus Memorial Hospital in Lodz, Poland, between the years 2010-2012. Patients above 75 years old whose diagnoses were coded with ICD-10 codes S00-S09 were included in the study. The patients' age, gender, the mechanism and cause of injury, their Glasgow Coma Scale (GCS) score at admission and the results of their head CTs were analyzed.

RESULTS: A total of 301 patients were included in the analysis. Intracranial abnormalities caused by trauma were detected in 24 patients (8%). Transient loss of consciousness (TLOC) was a cause of injury in 44 patients (14.6%) and was related to an increased risk of an abnormal CT scan result (OR 4.6, 95% CI, 1.2-18.4, p < 0.003). Other mechanisms related to an increased risk of post-traumatic intracranial pathology were high-energy mechanisms of injury and unexplained falls.

CONCLUSIONS: Ground-level falls are the most frequent mechanism of head trauma in older people. One of the most commonly identified mechanisms of a fall is TLOC. Head injuries due to TLOC entailed a high risk of intracranial pathology in the elderly population. The risk of trauma-related positive CT scans in patients with unexplained falls is high, and is similar to that observed in patients with TLOC. The highest risk of trauma-related positive CT scans is observed in patients who have suffered a high-energy trauma.