Hamden Khalief, Agresti Darin, Jeanmonod Rebecca, Woods Dexter, Reiter Mark, Jeanmonod Donald
Carilion Clinic, Department of Emergency Medicine, Blacksburg, VA.
St. Luke's University Hospital and Health Network, Department of Emergency, Medicine, Bethlehem, PA.
Am J Emerg Med. 2014 Aug;32(8):890-4. doi: 10.1016/j.ajem.2014.04.051. Epub 2014 May 12.
Falls are a major cause of morbidity in the elderly.
We describe the low-acuity elderly fall population and study which historical and clinical features predict traumatic intracranial injuries (ICIs).
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.
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.
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.
跌倒是老年人发病的主要原因。
我们描述低 acuity 老年跌倒人群，并研究哪些历史和临床特征可预测创伤性颅内损伤（ICI）。
这是一项对至少 65 岁因跌倒就诊于三级护理机构的患者进行的前瞻性观察研究。如果患者基线精神状态正常且未被分诊至创伤室，则符合入选标准。就诊时，治疗医生填写一份关于跌倒机制和体位、头部撞击史、头痛、意识丧失（LOC）以及头部创伤体征的数据表。治疗医生可自行决定是否进行影像学检查。随后查阅病历以确定影像学检查结果。所有患者在 30 天进行随访，以确定未进行影像学检查患者的结局。该研究经机构审查委员会批准。
共纳入 799 例患者；79.5%的患者接受了影像学检查。27 例患者发生 ICI（3.4%）。14 例为硬膜下血肿，7 例为蛛网膜下腔出血，3 例为脑挫伤，3 例为复合型损伤。逻辑回归显示与 ICI 相关的 2 个研究变量：LOC（比值比，2.8；置信区间，1.2 - 6.3）和头部创伤体征（比值比，13.2；置信区间，2.7 - 64.1）。头部撞击史、机制和体位、头痛以及抗凝和抗血小板药物的使用与 ICI 无关。
基线精神状态正常的老年跌倒患者 ICI 发生率较低。ICI 的最佳预测指标是头部创伤的体格检查结果和 LOC 病史。
