Timler Dariusz, Dworzyński Michał J, Szarpak Łukasz, Gaszyńska Ewelina, Dudek Krzysztof, Gałązkowski Robert
Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Poland.
Department of Emergency Medicine, Copernicus Memorial Hospital in Lodz, Poland.
Adv Clin Exp Med. 2015 Nov-Dec;24(6):1045-50. doi: 10.17219/acem/27565.
Head injuries in elderly people are a common cause of hospitalization at emergency departments. This group of patients is at high risk of post-traumatic intracranial pathology, which is diagnosed by computed tomography (CT) scanning of the head.
The aim of this study was to determine the incidence and outcomes of head trauma in older people in different scenarios, on the basis of CT scan findings.
The study involved a retrospective analysis of medical records of patients treated in the Emergency Department of Copernicus Memorial Hospital in Lodz, Poland, between the years 2010-2012. Patients above 75 years old whose diagnoses were coded with ICD-10 codes S00-S09 were included in the study. The patients' age, gender, the mechanism and cause of injury, their Glasgow Coma Scale (GCS) score at admission and the results of their head CTs were analyzed.
A total of 301 patients were included in the analysis. Intracranial abnormalities caused by trauma were detected in 24 patients (8%). Transient loss of consciousness (TLOC) was a cause of injury in 44 patients (14.6%) and was related to an increased risk of an abnormal CT scan result (OR 4.6, 95% CI, 1.2-18.4, p < 0.003). Other mechanisms related to an increased risk of post-traumatic intracranial pathology were high-energy mechanisms of injury and unexplained falls.
Ground-level falls are the most frequent mechanism of head trauma in older people. One of the most commonly identified mechanisms of a fall is TLOC. Head injuries due to TLOC entailed a high risk of intracranial pathology in the elderly population. The risk of trauma-related positive CT scans in patients with unexplained falls is high, and is similar to that observed in patients with TLOC. The highest risk of trauma-related positive CT scans is observed in patients who have suffered a high-energy trauma.
老年人头部受伤是急诊科住院的常见原因。这类患者发生创伤后颅内病变的风险很高，需通过头部计算机断层扫描（CT）来诊断。
本研究旨在根据CT扫描结果确定不同情况下老年人头部创伤的发生率和预后。
本研究对2010年至2012年期间在波兰罗兹哥白尼纪念医院急诊科接受治疗的患者病历进行回顾性分析。研究纳入年龄在75岁以上、诊断编码为ICD-10编码S00-S09的患者。分析了患者的年龄、性别、损伤机制和原因、入院时的格拉斯哥昏迷量表（GCS）评分以及头部CT结果。
共有301例患者纳入分析。24例患者（8%）检测到创伤引起的颅内异常。44例患者（14.6%）因短暂意识丧失（TLOC）导致受伤，且与CT扫描结果异常风险增加相关（比值比4.6，95%置信区间，1.2-18.4，p<0.003）。与创伤后颅内病变风险增加相关的其他机制包括高能量损伤机制和不明原因跌倒。
平地跌倒是老年人头部创伤最常见的机制。跌倒最常见的原因之一是TLOC。因TLOC导致的头部损伤在老年人群中颅内病变风险很高。不明原因跌倒患者创伤相关CT扫描阳性的风险很高，与TLOC患者相似。创伤相关CT扫描阳性风险最高的是遭受高能量创伤的患者。
