Journal Article

Cutaneous impact location: a new tool to predict intracranial lesion among the elderly with mild traumatic brain injury?

Balen, Frederic, Schmidt, Eric, Lauque, Dominique, Houze-Cerfon, Charles-Henri, Dubucs, Xavier, Houles, Mathieu, Charpentier, Sandrine

2020

Overview

Background Mild traumatic brain injury is the leading cause of arrivals to emergency department due to trauma in the 65-year-old population and over. Recent studies conducted in ED suggested a low intracranial lesion prevalence. The objectives of this study were to assess the prevalence and risk factors of intracranial lesion in older patients admitted to emergency department for mild traumatic brain injury by reporting in the emergency department the precise anamnesis of injury and clinical findings. Methods Patients of 65 years old and over admitted in emergency department were prospectively included in this monocentric study. The primary outcome was the prevalence of intracranial lesion threw neuroimaging. Results Between January and June 2019, 365 patients were included and 66.8% were women. Mean age was 86.5 years old (SD = 8.5). Ground-level fall was the most common cause of mild traumatic brain injury and occurred in 335 patients (91.8%). Overall, 26 out of 365 (7.2%) patients had an intracranial lesion. Compared with cutaneous frontal impact (medium risk group), the relative risk of intracranial lesion was 2.54 (95% CI 1.20 to 5.42) for patients with temporoparietal or occipital impact (high risk group) and 0.12 (95% CI 0.01 to 0.93) for patients with facial impact or no cutaneous impact (low risk group). There was not statistical increase in risk of intracranial injury with patients receiving antiplatelets (RR = 1.43; 95% CI 0.68 to 2.99) or anticoagulants (RR = 0.98; 95% CI 0.45 to 2.14). Conclusion Among patients of 65 years old and over, the prevalence of intracranial lesion after a mild traumatic brain injury was similar to the younger adult population. The cutaneous impact location on clinical examination at the emergency department may identify older patients with low, medium and high risk for intracranial lesion.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Aged, 80 and over / Anticoagulants / Antipsychotics / Aspirin / Benzodiazepines / Brain damage / Brain injuries / Brain Injuries, Traumatic - drug therapy / Brain Injuries, Traumatic - epidemiology / Brain Injuries, Traumatic - pathology / Cognitive ability / Confidence intervals / Consciousness / Elderly / Emergency department / Emergency medical care / Emergency Medicine / Emergency Service, Hospital / Epidemiology / Fainting / Female / Frailty / Hematoma / Hospitalization / Humans / Injuries / Lesions / Male / Medical research / Medicine / Medicine & Public Health / Mild traumatic brain injury / Neuroimaging / Nursing homes / Original Research / Patients / Population / Prevalence / Prognosis / Prospective Studies / Risk factors / Skin - pathology / Trauma / Traumatic brain injury / Traumatic Surgery