Elsevier

The Journal of Emergency Medicine

Volume 16, Issue 5, September–October 1998, Pages 709-713
The Journal of Emergency Medicine

Original Contributions
Elderly patients with closed head trauma after a fall: mechanisms and outcomes

Presented at the ACEP Research Forum, Cincinnati, Ohio, February 1996
https://doi.org/10.1016/S0736-4679(98)00083-3Get rights and content

Abstract

Falls in the elderly leading to closed head trauma represent a significant cause of morbidity and mortality in that population, but are not well-characterized. The purpose of this study was to determine the mechanism of fall, outcome, and additional risk factors in elderly patients who require cranial computed tomography (CT) scan after a fall. We conducted a retrospective case series of patients age 60 years and older with closed head trauma secondary to falling who underwent CT scan in the emergency department (ED). Data were gathered from ED and hospital records. The setting was an urban Level I trauma center. Our series consisted of 189 patients, of whom 31 (16%) had an abnormal head CT scan and four (2%) required neurosurgery. Cerebral contusions (38%) and subdural hematomas (33%) were the most common lesions seen on CT scan. Falls from standing (76%) were more common than falls on stairs (19%) or from height (5%), but the latter two were more likely to result in an abnormal CT scan (stairs 42%, height 40%). An abnormal neurologic examination was associated with a higher risk of the need for neurosurgery (risk ratio 11.5). We conclude that among elderly patients who fall and present to an ED with evidence of closed head trauma, a significant percentage will have abnormal CT scans but only a small minority will require neurosurgery. While falls from standing are more common, falls on stairs or from height are associated with a higher risk of having an abnormal CT scan. A focal neurologic examination is a strong predictor of the need for neurosurgical intervention.

Introduction

Falls are second only to motor vehicle accidents among unintentional traumatic causes of death in all ages, accounting for 11,300 fatalities in 1987 (1). Among the elderly, falls are particularly important; more than half the deaths due to unintentional injury in persons 65 and older are caused by falls (2). While the conventional wisdom is that falls from heights affect primarily children and working-age patients and that the elderly are at particular risk for falls on stairs, data are sparse; circumstances are not specified for about 80% of falls (3). Among falls in the elderly, injuries to the head and face represent approximately 12%–15% of all morbidity (4). We undertook this study to characterize the mechanism of injury among elderly patients with falls resulting in evidence of closed head trauma.

Section snippets

Materials and methods

Our design was a retrospective case series derived from a chart review of 189 consecutive patients aged 60 years and over who presented to our emergency department, a 65,000-annual-visit Level I trauma center, between October 1, 1992, and December 31, 1993. All of these patients had suffered blunt head trauma, either isolated or in conjunction with non-head trauma, and all had undergone cranial computed tomography (CT) scan. Victims of penetrating head trauma and patients transferred from other

Results

Over the time period of the study, 318 patients aged 60 years and above underwent head CT scan in our ED. Of these, 189 patients (59%) had a fall as their mechanism of injury, almost triple the second leading cause of injury, motor vehicle accidents (20%). These 189 patients form the basis for this report.

Table 1 lists the age distribution and mechanism of injury for these 189 patients. The majority (76%; 95% CI 70–82%) fell from standing, a mechanism of injury approximately four times as

Discussion

This study demonstrates that fall is the most common mechanism of injury in elderly patients requiring a head CT scan in our ED for evidence of closed head trauma. Falls represented the mechanism of injury in 59% of our population, almost three times as common as the second-leading mechanism, motor vehicle accidents (20%). Our results are similar to those of other studies examining the mechanism of trauma in elderly patients. In Edinburgh, Scotland, 67% of elderly patients admitted for minor

Acknowledgements

Thanks to YuChiao Chang, PhD, for statistical advice and to Teresa Burke and to Leo Mayer for secretarial support.

References (12)

There are more references available in the full text version of this article.

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