Epidemiology of maxillofacial trauma in elderly patients receiving oral anticoagulant or antithrombotic medication; a Swiss retrospective study.

Autor: Bettschen D; Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland., Tsichlaki D; Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland., Chatzimichail E; Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland.; Department of Ophthalmology, University Hospital of Basel, Basel, Switzerland., Klukowska-Rötzler J; Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland. jolanta.klukowska-roetzler@insel.ch., Müller M; Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland., Sauter TC; Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland., Exadaktylos AK; Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland., Ziaka M; Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland., Doulberis M; Gastroklinik, Private Gastroenterolgy Practice, 8810, Horgen, Switzerland.; Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, 5001, Aarau, Switzerland., Burkhard JP; Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, 3010, Bern, Switzerland. jp_burkhard@me.com.; Limat Cleft and Craniofacial Centere, 8005, Zurich, Switzerland. jp_burkhard@me.com.
Jazyk: angličtina
Zdroj: BMC emergency medicine [BMC Emerg Med] 2024 Jul 18; Vol. 24 (1), pp. 121. Date of Electronic Publication: 2024 Jul 18.
DOI: 10.1186/s12873-024-01039-1
Abstrakt: Background: The percentage of elderly trauma patients under anticoagulation and antiplatelet agents has been rising lately. As newer agents are introduced, each comes with its own advantages and precautions. Our study covered elderly patients admitted to the ED with maxillofacial trauma while on anticoagulation (AC) or antiplatelet therapy (APT). We aimed to investigate the demographic characteristics, causes, and types of maxillofacial trauma, along with concomitant injuries, duration of hospitalisation, haemorrhagic complications, and the overall costs of care in the emergency department (ED).
Methods: Data were gathered from the ED of Bern University Hospital. In this retrospective analysis, patients over 65 of age were included, who presented at our ED with maxillofacial trauma between 2013 and 2019 while undergoing treatment with therapeutic AC/APT.
Results: The study involved 188 patients with a median age of 81 years (IQR: 81 [74; 87]), of whom 55.3% (n=104) were male. More than half (54.8%, n=103) were aged 80 years or older. Cardiovascular diseases were present in 69.7% (n=131) of the patients, with the most common indications for AC/APT use being previous thromboembolic events (41.5%, n=78) and atrial fibrillation (25.5%, n=48). The predominant cause of facial injury was falls, accounting for 83.5% (n=157) of cases, followed by bicycle accidents (6.9%, n=13) and road-traffic accidents (5.3%, n=10). The most common primary injuries were fractures of the orbital floor and/or medial/lateral wall (60.1%, n=113), zygomatic bone (30.3%, n=57), followed by isolated orbital floor fractures (23.4%, n=44) and nasal bone fractures (19.1%, n=36). Fractures of the mandible occurred in 14.9% (n=28). Facial hematomas occurred in 68.6% of patients (129 cases), primarily in the midface area. Relevant facial bleeding complications were intracerebral haemorrhage being the most frequent (28.2%, n=53), followed by epistaxis (12.2%, n=23) and retrobulbar/intraorbital hematoma (9%, n=17). Sixteen patients (8.5%) experienced heavy bleeding that required emergency treatment. The in-hospital mortality rate was 2.1% (4 cases).
Conclusions: This study indicates that falls are the leading cause of maxillofacial trauma in the elderly, with the most common diagnoses being orbital, zygomatic, and nasal fractures. Haemorrhagic complications primarily involve facial hematomas, especially in the middle third of the face, with intracerebral haemorrhage being the second most frequent. Surgical intervention for bleeding was required in 8.5% of cases. Given the aging population, it is essential to improve prevention strategies and update safety protocols, particularly for patients on anticoagulant/antiplatelet therapy (AC/APT). This can ensure rapid diagnostic imaging and prompt treatment in emergencies.
(© 2024. The Author(s).)
Databáze: MEDLINE
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