Title: Intracranial Pathology in Elders with Blunt Head Trauma
Abstract: Academic Emergency MedicineVolume 13, Issue 3 p. 302-307 Free Access Intracranial Pathology in Elders with Blunt Head Trauma Niels K. Rathlev MD, Corresponding Author Niels K. Rathlev MD Department of Emergency Medicine, Boston Medical Center, Boston, MA*Department of Emergency Medicine, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118. Fax: 617-414-7759; e-mail: [email protected]Search for more papers by this authorRon Medzon MD, Ron Medzon MD Department of Emergency Medicine, Boston Medical Center, Boston, MASearch for more papers by this authorDoug Lowery MD, Doug Lowery MD Department of Emergency Medicine, Emory University Medical Center, Atlanta, GASearch for more papers by this authorCharles Pollack MD, Charles Pollack MD Department of Emergency Medicine, Pennsylvania Hospital, Philadelphia, PASearch for more papers by this authorMark Bracken MD, Mark Bracken MD Department of Emergency Medicine, Boston Medical Center, Boston, MASearch for more papers by this authorGlenn Barest MD, Glenn Barest MD Department of Radiology (GB), Boston Medical Center, Boston, MASearch for more papers by this authorAllan B. Wolfson MD, Allan B. Wolfson MD Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PASearch for more papers by this authorJerome R. Hoffman MA, MD, Jerome R. Hoffman MA, MD Department of Emergency Medicine, University of California Medical Center, Los Angeles, CASearch for more papers by this authorWilliam R. Mower MD, PhD, William R. Mower MD, PhD Department of Emergency Medicine, University of California Medical Center, Los Angeles, CASearch for more papers by this author Niels K. Rathlev MD, Corresponding Author Niels K. Rathlev MD Department of Emergency Medicine, Boston Medical Center, Boston, MA*Department of Emergency Medicine, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118. Fax: 617-414-7759; e-mail: [email protected]Search for more papers by this authorRon Medzon MD, Ron Medzon MD Department of Emergency Medicine, Boston Medical Center, Boston, MASearch for more papers by this authorDoug Lowery MD, Doug Lowery MD Department of Emergency Medicine, Emory University Medical Center, Atlanta, GASearch for more papers by this authorCharles Pollack MD, Charles Pollack MD Department of Emergency Medicine, Pennsylvania Hospital, Philadelphia, PASearch for more papers by this authorMark Bracken MD, Mark Bracken MD Department of Emergency Medicine, Boston Medical Center, Boston, MASearch for more papers by this authorGlenn Barest MD, Glenn Barest MD Department of Radiology (GB), Boston Medical Center, Boston, MASearch for more papers by this authorAllan B. Wolfson MD, Allan B. Wolfson MD Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PASearch for more papers by this authorJerome R. Hoffman MA, MD, Jerome R. Hoffman MA, MD Department of Emergency Medicine, University of California Medical Center, Los Angeles, CASearch for more papers by this authorWilliam R. Mower MD, PhD, William R. Mower MD, PhD Department of Emergency Medicine, University of California Medical Center, Los Angeles, CASearch for more papers by this author First published: 28 June 2008 https://doi.org/10.1197/j.aem.2005.10.015Citations: 41AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract 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. 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