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Mild head trauma in elderly patients: experience of an emergency department

INTRODUCTION: We evaluated the risk profile of elderly patients who came to the emergency department for mild head trauma. The primary goal was to determine the difference in the incidence of posttraumatic intracranial hemorrhage (ICH) after minor head injury (MHI). The secondary objective was to as...

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Autores principales: Savioli, Gabriele, Ceresa, Iride Francesca, Ciceri, Luca, Sciutti, Fabio, Belliato, Mirko, Iotti, Giorgio Antonio, Luzzi, Sabino, Del Maestro, Mattia, Mezzini, Gianluca, Lafe, Elvis, Simoncelli, Anna, Ricevuti, Giovanni, Manzoni, Federica, Bressan, Maria Antonietta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347629/
https://www.ncbi.nlm.nih.gov/pubmed/32671238
http://dx.doi.org/10.1016/j.heliyon.2020.e04226
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author Savioli, Gabriele
Ceresa, Iride Francesca
Ciceri, Luca
Sciutti, Fabio
Belliato, Mirko
Iotti, Giorgio Antonio
Luzzi, Sabino
Del Maestro, Mattia
Mezzini, Gianluca
Lafe, Elvis
Simoncelli, Anna
Ricevuti, Giovanni
Manzoni, Federica
Bressan, Maria Antonietta
author_facet Savioli, Gabriele
Ceresa, Iride Francesca
Ciceri, Luca
Sciutti, Fabio
Belliato, Mirko
Iotti, Giorgio Antonio
Luzzi, Sabino
Del Maestro, Mattia
Mezzini, Gianluca
Lafe, Elvis
Simoncelli, Anna
Ricevuti, Giovanni
Manzoni, Federica
Bressan, Maria Antonietta
author_sort Savioli, Gabriele
collection PubMed
description INTRODUCTION: We evaluated the risk profile of elderly patients who came to the emergency department for mild head trauma. The primary goal was to determine the difference in the incidence of posttraumatic intracranial hemorrhage (ICH) after minor head injury (MHI). The secondary objective was to assess worse outcome, such as: hospitalization rate, rate of re-admission, need of neurosurgery. We also assess the admission process times and length of hospital stay. The ultimate goal was to optimize the diagnostic-observational management of minor head trauma in elderly patients. MATERIAL AND METHODS: We evaluated all patients with MHI who came to our emergency department during 2017 and 2018. All patients underwent computed tomography. RESULTS: We enrolled 2325 patients, of whom 1094 were 75 years of age or older. The population was divided into two categories according to age: The “elderly population” was 75 or older, and the younger patients were younger than 75. The elderly population, in comparison with the younger patients, had a higher rate of ICH (12.1% versus 5.1%), a higher hospitalization rate (11.7% versus 5.5%), and a higher rate of readmission within 30 days (6.8% versus 3.2%). The elderly population also had longer admission process times (8 h, 25 min, versus 4 h, 09 min) and longer lengths of hospital stay (9 h, 41 min, versus 5 h, 29 min). Of the younger patients, 92% (versus 41% of the elderly population) did not take any drugs, 6% (versus 39%) were receiving antiplatelet therapy, 1% (versus 13%) took vitamin K antagonists, and 1% (versus 7%) took oral direct-acting anticoagulants. Logistic regression models revealed that a 1-year increase in age raised the risk of bleeding by 2% on average; this finding was statistically significant (odds ratio [OR], 1023/year, p < 0.001). The rate of ICH increased significantly after the age of 75, by 180% (OR, 2.82; p < 0.001). CONCLUSIONS: These data suggest that age is an independent risk factor for ICH, whereby the age of 75 entails a 180% increase in the risk of bleeding.
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spelling pubmed-73476292020-07-14 Mild head trauma in elderly patients: experience of an emergency department Savioli, Gabriele Ceresa, Iride Francesca Ciceri, Luca Sciutti, Fabio Belliato, Mirko Iotti, Giorgio Antonio Luzzi, Sabino Del Maestro, Mattia Mezzini, Gianluca Lafe, Elvis Simoncelli, Anna Ricevuti, Giovanni Manzoni, Federica Bressan, Maria Antonietta Heliyon Article INTRODUCTION: We evaluated the risk profile of elderly patients who came to the emergency department for mild head trauma. The primary goal was to determine the difference in the incidence of posttraumatic intracranial hemorrhage (ICH) after minor head injury (MHI). The secondary objective was to assess worse outcome, such as: hospitalization rate, rate of re-admission, need of neurosurgery. We also assess the admission process times and length of hospital stay. The ultimate goal was to optimize the diagnostic-observational management of minor head trauma in elderly patients. MATERIAL AND METHODS: We evaluated all patients with MHI who came to our emergency department during 2017 and 2018. All patients underwent computed tomography. RESULTS: We enrolled 2325 patients, of whom 1094 were 75 years of age or older. The population was divided into two categories according to age: The “elderly population” was 75 or older, and the younger patients were younger than 75. The elderly population, in comparison with the younger patients, had a higher rate of ICH (12.1% versus 5.1%), a higher hospitalization rate (11.7% versus 5.5%), and a higher rate of readmission within 30 days (6.8% versus 3.2%). The elderly population also had longer admission process times (8 h, 25 min, versus 4 h, 09 min) and longer lengths of hospital stay (9 h, 41 min, versus 5 h, 29 min). Of the younger patients, 92% (versus 41% of the elderly population) did not take any drugs, 6% (versus 39%) were receiving antiplatelet therapy, 1% (versus 13%) took vitamin K antagonists, and 1% (versus 7%) took oral direct-acting anticoagulants. Logistic regression models revealed that a 1-year increase in age raised the risk of bleeding by 2% on average; this finding was statistically significant (odds ratio [OR], 1023/year, p < 0.001). The rate of ICH increased significantly after the age of 75, by 180% (OR, 2.82; p < 0.001). CONCLUSIONS: These data suggest that age is an independent risk factor for ICH, whereby the age of 75 entails a 180% increase in the risk of bleeding. Elsevier 2020-07-07 /pmc/articles/PMC7347629/ /pubmed/32671238 http://dx.doi.org/10.1016/j.heliyon.2020.e04226 Text en © 2020 The Author(s) http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Savioli, Gabriele
Ceresa, Iride Francesca
Ciceri, Luca
Sciutti, Fabio
Belliato, Mirko
Iotti, Giorgio Antonio
Luzzi, Sabino
Del Maestro, Mattia
Mezzini, Gianluca
Lafe, Elvis
Simoncelli, Anna
Ricevuti, Giovanni
Manzoni, Federica
Bressan, Maria Antonietta
Mild head trauma in elderly patients: experience of an emergency department
title Mild head trauma in elderly patients: experience of an emergency department
title_full Mild head trauma in elderly patients: experience of an emergency department
title_fullStr Mild head trauma in elderly patients: experience of an emergency department
title_full_unstemmed Mild head trauma in elderly patients: experience of an emergency department
title_short Mild head trauma in elderly patients: experience of an emergency department
title_sort mild head trauma in elderly patients: experience of an emergency department
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347629/
https://www.ncbi.nlm.nih.gov/pubmed/32671238
http://dx.doi.org/10.1016/j.heliyon.2020.e04226
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