Minor head injury in the elderly at very low risk: a retrospective study of 6 years in an Emergency Department (ED).

Autor: Riccardi A, Frumento F, Guiddo G, Spinola MB, Corti L, Minuto P, Lerza R, Riccardi, Alessandro, Frumento, Flavio, Guiddo, Grazia, Spinola, Maria Beatrice, Corti, Luca, Minuto, Pierangela, Lerza, Roberto
Zdroj: American Journal of Emergency Medicine; 2013, Vol. 31 Issue 1, p37-41, 5p
Abstrakt: Introduction: Mild head injury (MHI) is a common clinical problem in emergency departments (EDs). Long-standing debate is still going on about MHI in the elderly: current guidelines recommend to perform a CT scan on this group. Materials and Methods: We performed a retrospective study by reviewing patients older than 65 years, evaluated in our ED for which a CT scan of the head was performed for MHI, between 2004 and 2010. According to Italian Guidelines, we considered only patients with low-risk MHI. Results: We considered 2149 eligible patients: we recorded 47 pathological acute findings on CT scan (2.18%), but only 3 patients (0.14%) underwent neurosurgery. We analysed our patients according to different age groups: in patients in the 65- to 79-year-old group, we documented pathological findings on CT in 0.66% of cases, with a significant increase in the group older than 80 years, with a rate of 3.33% of acute findings on CT (OR 5.22, P < .001); 617 patients were on antiplatelet therapy: 22 of these patients (3.72%) had a pathological finding on CT scan (OR 2.23, P < .005). Discussion: Our retrospective analyses demonstrated that the incidence of intracranial complications after MHI is not different from that of the general population, and based on this finding, a CT does not seem to be necessary, at least up to 80 years old. Our data suggest that antiplatelet therapy could be a significant risk factor. Our results suggest that elderly patients between 65 and 79 years old without risk factors could be managed as younger patients. [ABSTRACT FROM AUTHOR]
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