title: Minor head injury in the elderly at very low risk: a retrospective study of 6 years in an Emergency Department (ED).
abstract: BACKGROUND
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: S.C. Medicina e Chirurgia d'Accettazione e d'Urgenza-OBI, Ospedale San Paolo, Savona, 17100 Savona (SV), Italia. a.riccardi@asl2.liguria.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Riccardi
authors.forename: Flavio
authors.initials: F
authors.lastname: Frumento
authors.forename: Grazia
authors.initials: G
authors.lastname: Guiddo
authors.forename: Maria Beatrice
authors.initials: MB
authors.lastname: Spinola
authors.forename: Luca
authors.initials: L
authors.lastname: Corti
authors.forename: Pierangela
authors.initials: P
authors.lastname: Minuto
authors.forename: Roberto
authors.initials: R
authors.lastname: Lerza
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000601:surgery; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants