Prevalence and characteristics of traumatic intracranial hemorrhage in elderly fallers presenting to the emergency department without focal findings.
OBJECTIVE
To determine the prevalence and associated characteristics of traumatic intracranial hemorrhage (ICH) in elderly fallers presenting to the emergency department (ED) without focal findings.


METHODS
Retrospective cohort study.


METHODS
University-affiliated teaching hospital ED.


METHODS
Patients aged 65 and older presenting with a fall to the ED and undergoing a head computed tomography (CT) scan.


METHODS
Electronic medical records and CT scans of 404 consecutive patients were reviewed. Characteristics of patients with and without ICH were compared using unadjusted analyses. Patients taking warfarin, aspirin, or clopidogrel alone or in combination were compared with those not taking these medications. Multivariate logistic regression analyses were performed to determine variables independently associated with ICH.


RESULTS
Forty-seven of 404 elderly fallers (11.6%) without focal findings had an ICH. Unadjusted analyses in these pilot data showed that warfarin was not significantly associated with ICH. Multivariate analyses indicated that elderly people living in at home were more likely to have ICH than those living in nursing homes or assisted living facilities (odds ratio (OR)=3.2, 95% confidence interval (CI)=1.30-8.13) and that those with head trauma were more likely to have ICH than those without (OR=3.9, 95% CI=1.25-7.80). Aspirin was found to be protective (OR=0.49, 95% CI=0.24-0.98).


CONCLUSIONS
ICH is common in elderly fallers presenting to the ED without focal findings. Anticoagulation alone did not appear to increase the risk of ICH, and aspirin was found to be protective, but prospective studies are needed to better assess this relationship.
Gangavati
Anupama S
AS
Department of Medicine, Division of Gerontology, Beth Israel Deaconess Medical Center, Massachusetts 02215, USA. agangava@bidmc.harvard.edu
Kiely
Dan K
DK
Kulchycki
Lara K
LK
Wolfe
Richard E
RE
Mottley
J Lawrence
JL
Kelly
Sean P
SP
Nathanson
Larry A
LA
Abrams
Alan P
AP
Lipsitz
Lewis A
LA
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D016009:Chi-Square Distribution; D000077144:Clopidogrel; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000008:administration & dosage
D000925:Anticoagulants; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin