Journal Article

Delayed intracranial hemorrhage in elderly anticoagulated patients sustaining a minor fall

Birmingham, Lauren E., Mann, Nolan, Marchand, Tiffany D., George, Richard L., Wietecha, Katherine, Martin, Andrew, Welch, Kellen, Subichin, Michael

2018

Overview

Background Falls are a common cause of hospitalization, morbidity, and mortality among the elderly in the United States. Evidence-based imaging recommendations for evaluation of delayed intracranial hemorrhage (DICH) are not generally agreed upon. The purpose of this project was to evaluate the incidence of DICH detected by head computer tomography (CT) among an elderly population on pre-injury anticoagulant or antiplatelet (ACAP) therapy. Methods Data from a Level 1 Trauma Center trauma registry was used to assess the incidence of DICH in an elderly population of patients (≥65 years) who sustained a minor fall while on pre-injury ACAP medications. Counts and percentages are reported. Results Data on 1076 elderly trauma patients were downloaded, of which 838 sustained a minor fall and 513 were found to be using a pre-injury ACAP medication. One patient (0.46%) with a DICH was identified out of 218 patients who received a routine repeat head CT. Aspirin and warfarin were the most common pre-injury ACAP medications and 19.27% (42/218) of patients were found to be using multiple ACAP medications. Conclusions Universal screening protocols promote immediate-term patient safety, but do so at a great expense with respect to health expenditures and increased radiation exposure. This analysis highlights the need for an effective risk assessment tool for DICH that would reduce the burden of unnecessary screenings while still identifying life-threatening intracranial hemorrhages in affected patients.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Accidental falls / Accidental Falls - statistics & numerical data / Aged / Aged, 80 and over / Analysis / Anticoagulants / Anticoagulants - administration & dosage / Anticoagulants - adverse effects / Aspirin / Brain hemorrhage / CAT scans / Computed tomography / Delayed intracranial hemorrhage / Diagnosis / Drug Therapy, Combination / Elderly / Elderly patients / Emergency medical care / Emergency Medicine / Fall / Female / Geriatrics / Head injuries / Head injury / Health aspects / Health care costs / Health risk assessment / Health screening / Hemorrhage / Humans / Intracranial hemorrhage / Intracranial Hemorrhages - diagnostic imaging / Intracranial Hemorrhages - etiology / Male / Medical imaging / Medicine / Medicine & Public Health / Morbidity / Platelet Aggregation Inhibitors - administration & dosage / Platelet Aggregation Inhibitors - adverse effects / Research Article / Retrospective Studies / Risk assessment / Safety and security measures / Tomography, X-Ray Computed / Trauma / Trauma centers / Trauma emergency medicine / Warfarin