Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
J Am Geriatr Soc. 2020 May;68(5):970-976. doi: 10.1111/jgs.16338. Epub 2020 Feb 3.
Emergency department (ED) visits among older adults are frequently instigated by a fall at home. Some of these patients develop intracranial bleeding. The aim of this study was to identify the incidence of intracranial bleeding and the associated clinical features in older adults who present to the ED after falling.
Prospective cohort study.
Three Canadian EDs.
A total of 2 176 patients age 65 years or older who presented to the ED with a fall were assessed, and 1753 were included. Inclusion criteria were a fall on level ground, off a bed, chair, or toilet, or from one or two steps within 48 hours.
Emergency physicians recorded predefined clinical findings on initial assessment. The primary outcome was intracranial bleeding, diagnosed either by computed tomography at the index visit or within 42 days. Associations between baseline clinical findings and the presence of intracranial bleeding were assessed with multivariable logistic regression.
A total of 1753 patients (median age = 82 y) were enrolled, of whom 39% were male, 35% were on antiplatelet therapy, and 25% were on an anticoagulant. The incidence of intracranial bleeding was 5.0% (95% confidence interval [CI] = 4.1-6.1). Overall, 76 patients were diagnosed at the index ED visit, and 12 were diagnosed during follow-up. Multivariable regression identified four clinical variables that were independently associated with intracranial bleeding: new abnormalities on neurologic examination (odds ratio [OR] = 4.4; 95% CI = 2.4-8.1), bruise or laceration on the head (OR = 4.3; 95% CI = 2.7-7.0), chronic kidney disease (OR = 2.4; 95% CI = 1.3-4.6), and reduced Glasgow Coma Scale from normal (OR = 1.9; 95% CI = 1.0-3.4).
The incidence of intracranial bleeding in our study was 5.0%. We found significant associations between intracranial bleeding and four simple clinical variables. We did not find significant associations between intracranial bleeding and antiplatelet or anticoagulant use. J Am Geriatr Soc 68:970-976, 2020.
老年人因跌倒而频繁到急诊科就诊。其中一些患者会出现颅内出血。本研究旨在确定在跌倒后到急诊科就诊的老年人中颅内出血的发生率和相关临床特征。
前瞻性队列研究。
加拿大的 3 家急诊科。
共有 2176 名年龄在 65 岁或以上的患者因跌倒到急诊科就诊，其中 1753 名患者符合纳入标准，即平地跌倒、从床上、椅子或马桶上跌落，或从 1 到 2 个台阶上跌落，时间在 48 小时内。
急诊医生在初始评估时记录预先设定的临床发现。主要结局是通过就诊时的计算机断层扫描或 42 天内的检查诊断出颅内出血。使用多变量逻辑回归评估基线临床特征与颅内出血之间的关联。
共纳入 1753 名患者（中位数年龄=82 岁），其中 39%为男性，35%正在服用抗血小板药物，25%正在服用抗凝药物。颅内出血的发生率为 5.0%（95%置信区间[CI]：4.1-6.1）。总体而言，76 名患者在就诊时即被诊断出颅内出血，还有 12 名患者在随访期间被诊断出。多变量回归确定了 4 个与颅内出血独立相关的临床变量：神经系统检查有新的异常（比值比[OR]：4.4；95% CI：2.4-8.1）、头部有瘀伤或撕裂伤（OR：4.3；95% CI：2.7-7.0）、慢性肾脏病（OR：2.4；95% CI：1.3-4.6）和格拉斯哥昏迷量表评分从正常变为异常（OR：1.9；95% CI：1.0-3.4）。
本研究中颅内出血的发生率为 5.0%。我们发现颅内出血与 4 个简单的临床变量之间存在显著关联。我们未发现颅内出血与抗血小板或抗凝药物使用之间存在显著关联。美国老年医学会 68：970-976，2020 年。
