Intracranial Pathology in Elders with Blunt Head Trauma

Objectives: To examine presentations and prevalence of head injury among elder victims of blunt trauma and to estimate the prevalence of occult injuries associated with a normal level of consciousness, absence of neurologic deficit, and no evidence of significant skull fracture. Methods: The study population consisted of all patients aged 65 years or older enrolled in the National Emergency X-Radiography Utilization Study (NEXUS) II head injury cohort. The authors assessed the prevalence and patterns of intracranial injuries among this cohort and compared the prevalence of specific presenting signs and symptoms among injured and uninjured patients. An occult injury subcohort was also constructed, and injury prevalence was examined among this group. Results: A total of 1,934 elder patients were identified among the 13,326 subjects in NEXUS II (14.5%). Significant intracranial injury, defined as an injury that typically requires procedural intervention or is associated with persistent neurologic impairment or long-term disability, was found in 178 elder patients (9.2%; 95% confidence interval = 8.0% to 10.6%) as compared with 697 individuals among 11,392 younger patients (6.1%; 95% confidence interval = 5.7% to 6.6%). Focal neurologic deficits were present in 55.8% of elder patients with injury. Prevalence of specific injuries among elder and younger patients, respectively, included the following: subdural hematoma, 4.4% and 2.4%; contusion, 4.0% and 3.2%; epidural hematoma, 0.5% and 1.0%; and depressed skull fracture, 0.2% and 0.5%. Forty-two elder patients (2.2%) had an occult injury, compared with only 92 younger patients (0.8%). Conclusions: Elder patients with head trauma are at higher risk of developing a significant intracranial injury, including subdural and epidural hematoma. An occult presentation is also more common in elders. ACADEMIC EMERGENCY MEDICINE 2006; 13:302–307 a 2006 by the Society for Academic Emergency Medicine