Intracranial bleeding rare among older fall patients

Intracranial bleeding has a relatively low incidence rate among elderly adults who present to the emergency department for falls, a recent study has found.

The study included 1,753 elderly patients (median age 82 years, 39 percent male) who had fallen and from whom emergency physicians had collected pertinent clinical information, such as loss of consciousness, retrospective amnesia and vomiting. The primary outcome was intracranial bleeding detected using a head computed tomography scan.

Eighty-eight participants were diagnosed with intracranial bleeding, resulting in an incidence rate of 5.0 percent. Majority (n=76) were detected during the index emergency visit, while 12 cases were found during the 42-day follow-up period. Eighteen of these patients died.

Multivariable logistic regression analysis revealed four factors significantly predictive of intracranial bleeding in elderly fall patients. The strongest of these was the detection of a new abnormality on neurologic examination, which caused at least a fourfold increase in risk (odds ratio [OR], 4.35, 95 percent confidence interval [CI], 2.35–8.05).

Head lacerations or bruises were likewise a strong risk factor (OR, 4.33, 95 percent CI, 2.70–6.96), followed by chronic kidney disease (OR, 2.36, 95 percent CI, 1.25–4.56) and the reduction from normal in the Glasgow Coma Score tool (OR, 1.87, 95 percent CI, 1.04–3.36). Anticoagulant and antiplatelet use was both unrelated to the risk of intracranial bleeding.

Further prospective studies are needed to confirm the present findings and to expand understanding of intracranial bleeding in this population.