Original ContributionsElderly patients with closed head trauma after a fall: mechanisms and outcomes
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.
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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.
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