title: Characteristics of elderly fall patients with baseline mental status: high-risk features for intracranial injury.
abstract: BACKGROUND
  Falls are a major cause of morbidity in the elderly.
  
  
  OBJECTIVE
  We describe the low-acuity elderly fall population and study which historical and clinical features predict traumatic intracranial injuries (ICIs).
  
  
  METHODS
  This is a prospective observational study of patients at least 65 years old presenting with fall to a tertiary care facility. Patients were eligible if they were at baseline mental status and were not triaged to the trauma bay. At presentation, a data form was completed by treating physicians regarding mechanism and position of fall, history of head strike, headache, loss of consciousness (LOC), and signs of head trauma. Radiographic imaging was obtained at the discretion of treating physicians. Medical records were subsequently reviewed to determine imaging results. All patients were called in follow-up at 30 days to determine outcome in those not imaged. The study was institutional review board approved.
  
  
  RESULTS
  A total of 799 patients were enrolled; 79.5% of patients underwent imaging. Twenty-seven had ICIs (3.4%). Fourteen had subdural hematoma, 7 had subarachnoid hemorrhage, 3 had cerebral contusion, and 3 had a combination of injuries. Logistic regression demonstrated 2 study variables that were associated with ICIs: LOC (odds ratio, 2.8; confidence interval, 1.2-6.3) and signs of head trauma (odds ratio, 13.2; confidence interval, 2.7-64.1). History of head strike, mechanism and position, headache, and anticoagulant and antiplatelet use were not associated with ICIs.
  
  
  CONCLUSIONS
  Elderly fall patients who are at their baseline mental status have a low incidence of ICIs. The best predictors of ICIs are physical findings of trauma to the head and history of LOC.
authors.affiliation: Carilion Clinic, Department of Emergency Medicine, Blacksburg, VA.
authors.forename: Khalief
authors.initials: K
authors.lastname: Hamden
authors.affiliation: St. Luke's University Hospital and Health Network, Department of Emergency, Medicine, Bethlehem, PA.
authors.forename: Darin
authors.initials: D
authors.lastname: Agresti
authors.affiliation: St. Luke's University Hospital and Health Network, Department of Emergency, Medicine, Bethlehem, PA. Electronic address: rebeccajeanmonod@yahoo.com.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jeanmonod
authors.affiliation: University of Tennessee School of Medicine, Department of Emergency Medicine, Nashville, TN.
authors.forename: Dexter
authors.initials: D
authors.lastname: Woods
authors.affiliation: University of Tennessee School of Medicine, Department of Emergency Medicine, Nashville, TN.
authors.forename: Mark
authors.initials: M
authors.lastname: Reiter
authors.affiliation: St. Luke's University Hospital and Health Network, Department of Emergency, Medicine, Bethlehem, PA.
authors.forename: Donald
authors.initials: D
authors.lastname: Jeanmonod
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D059906:Neuroimaging; D011446:Prospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers / Q000706:statistics & numerical data; D014474:Unconsciousness / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology