ELDER PATIENTS WITH CLOSED-HEAD TRAUMA - A COMPARISON WITH NONELDER PATIENTS

Objective: Little is known about the circumstances surrounding closed head trauma (CHT) in elders, and how they differ from nonelders. The s tudy objective was to compare the 2 populations for outcome (positive cranial CT scan depicting traumatic injury, or the need for neurosurge ry), mechanism of injury, and the value of the neurologic examination to predict a CT scan positive for traumatic injury or the need for neu rosurgical intervention. Methods: A retrospective study was conducted by collecting a case series of patients with blunt head trauma who und erwent CT scanning, and comparing elder (aged greater than or equal to 60 years) with nonelder patients. The setting was the ED of a univers ity-affiliated Level-1 trauma center. Results: Twenty percent of the e lders and 13% of the nonelders had CT scans positive for traumatic inj ury, which conferred a risk ratio of 1.58 (95% CI 1.21-2.05). Older wo men were more at risk for the need for neurosurgery than were younger ones (3.1 vs 0.3%, RR 10.66, 95% CI 1.26-90.46). Among the elders, fal ls were the dominant mechanism of closed head trauma, followed by moto r vehicle collisions (MVCs), then being struck as a pedestrian. In the nonelders, MVCs, falls, and assaults were the most important mechanis ms of injury. A focally abnormal neurologic examination imparted an in creased risk for both a CT scan positive for traumatic injury (elder 4 .39, 95% CI 2.91-6.62; nonelder 7.75, 95% CI 5.53-10.72) and the need for neurosurgery (elder 35.68, 95% CI 4.58-275.89; nonelder 142.58, 95 % CI 19.11-1064.22) in both age groups. Conclusions: Significant diffe rences exist between elder and nonelder victims of CHT with respect to mechanisms of trauma and outcomes (CT scan positive for traumatic inj ury, or the need for neurosurgery).