Birmingham University Medical School, Birmingham, UK.
St Mary's Hospital, London, UK.
Clin Med (Lond). 2019 Mar;19(2):177-184. doi: 10.7861/clinmedicine.19-2-177.
Head injury is a common cause for hospital admission and additionally 250,000 UK inpatients fall during hospital admissions annually. Head injury most commonly occurs as a result of falls from standing height in older adults. Older adults are frequently frail and multi-morbid; many have indications for anticoagulation and antiplatelet agents. The haemorrhagic complications of head injury occur in up to 16% of anticoagulated patients sustaining a head injury. These patients suffer adverse outcomes from surgery as a result of medical complications. Although geriatric trauma models are evolving to meet the demand of an ageing trauma population, medical support to trauma services is commonly delivered by general physicians, many of whom lack experience and training in this field. Determining the role of surgery and interrupted anticoagulation requires careful personalised risk assessment. Appreciation of the opposing risks can be challenging; it requires an understanding of the evidence base in both surgery and medicine to rationalise decision making and inform communication. This article aims to provide an overview for the physician with clinical responsibility for patients who have sustained head injury.
头部损伤是导致住院的常见原因，此外，英国每年有 25 万住院患者在住院期间跌倒。头部损伤最常见于老年人从站立高度跌倒的结果。老年人通常身体虚弱且多病共存；许多人有抗凝和抗血小板药物的适应证。头部损伤导致高达 16%的接受抗凝治疗的患者发生出血性并发症。这些患者因医疗并发症而导致手术结果不良。尽管老年创伤模型正在发展以满足老龄化创伤人群的需求，但创伤服务的医疗支持通常由普通医生提供，其中许多人缺乏该领域的经验和培训。确定手术和中断抗凝的作用需要仔细的个性化风险评估。理解相反的风险具有挑战性；它需要了解手术和医学领域的证据基础，以合理化决策并提供沟通。本文旨在为负责头部受伤患者的临床医生提供概述。
