Emergency Department, University Hospital, 35033, Rennes, France.
University of Rennes, CHU Rennes, EA 7449 (Pharmacoepidemiology and Health Services Research) REPERES, University Hospital, F-35043, Rennes, France.
Intern Emerg Med. 2022 Aug;17(5):1309-1319. doi: 10.1007/s11739-021-02914-6. Epub 2022 Feb 3.
Among nonagenarians admitted to our emergency department (ED) for ground-level falls, we assessed the impact of pre-injury antithrombotic (AT) treatment on the post-traumatic consequences, and identified risk factors for 1-month mortality. All eligible patients were consecutively included over an 18-month period. Head trauma was attested by reliable medical history, witnesses or recent external signs. Patient characteristics, post-traumatic consequences and outcomes were compared across patients with and without AT. Risk factors for 1-month mortality were assessed using multivariate logistic regression analyses. 1014 consecutive nonagenarians were analysed, 675 (66.6%) with AT and 339 (33.4%) without. Head trauma (n = 429, 42.3%) was significantly more frequent among patients with AT (49.2 vs 28.6%, p < 0.001). Intracranial hemorrhage (ICH, n = 43, 4.2%), mostly subdural hematomas (58%), were more frequently found among patients with AT (p < 0.015). At least one fracture was diagnosed for 23.9% of the population, mostly hip fractures, without any significant association with AT. At 1 month, 103 patients (10.2%) had died. The independent risk factors for 1-month mortality were: ICH associated with head trauma (OR = 5.9, 95% CI 2.5-14), Glasgow coma score ≤ 12 at admission (OR = 10; 95% CI 2.2-46), atrial fibrillation (OR = 2.2, 95% CI 1.4-3.4) and age ≥ 95 years (OR = 1.6, 95% CI 1.0-2.5). Our results support accurate and regular assessment of the benefit/risk ratio for antithrombotic treatment among elderly people at high risk for falls.
在因平地摔倒而入住我们急诊科的 90 岁以上老年人中，我们评估了受伤前抗血栓（AT）治疗对创伤后后果的影响，并确定了 1 个月死亡率的危险因素。所有符合条件的患者在 18 个月的时间内连续纳入。头部创伤由可靠的病史、目击者或近期外部迹象证实。比较了有和没有 AT 的患者的患者特征、创伤后后果和结局。使用多变量逻辑回归分析评估 1 个月死亡率的危险因素。分析了 1014 例连续的 90 岁以上老年人，其中 675 例（66.6%）有 AT，339 例（33.4%）没有 AT。有 AT（49.2%）的患者头部创伤（n=429，42.3%）明显更常见（42.3%比 28.6%，p<0.001）。颅内出血（ICH，n=43，4.2%），主要为硬膜下血肿（58%），在有 AT 的患者中更常见（p<0.015）。23.9%的人群诊断出至少一处骨折，主要为髋部骨折，与 AT 无明显关联。1 个月时，103 例患者（10.2%）死亡。1 个月死亡率的独立危险因素为：伴有头部创伤的 ICH（OR=5.9，95%CI 2.5-14）、入院时格拉斯哥昏迷评分≤12（OR=10；95%CI 2.2-46）、心房颤动（OR=2.2，95%CI 1.4-3.4）和年龄≥95 岁（OR=1.6，95%CI 1.0-2.5）。我们的结果支持对高跌倒风险的老年人进行抗血栓治疗的获益/风险比进行准确和定期评估。
