Cutaneous Impact Location Predicts Intracranial Injury Among the Elderly Population with Traumatic Brain Injury

Abstract

Background

Traumatic brain injury (TBI) is one of the most common trauma-related diagnoses among the elderly population treated in emergency departments (ED). Identification of patients with increased or decreased risk of intracranial bleeding is of clinical importance. The objective of this study was to evaluate the implication of cutaneous impact location (CIL) on the prevalence of intracranial injury after suspected or confirmed TBI irrespective of its severity.

Methods

This was a retrospective, single-center, descriptive observational study of geriatric patients aged 65 years and older treated for suspected or confirmed TBI in a trauma surgery ED. The primary outcome of the study was the assessment of a CIL of the injury and its association with the prevalence of intracranial lesions found on a head computed tomography scan.

Results

Among 381 patients included in the analysis, the CIL of interest (temporo-parietal and occipital impacts) was present among 178 (46.7%) cases. Thirty-six (9.5%) patients were diagnosed with intracranial bleeding. The prevalence of intracranial bleeding was higher in the CIL of interest group compared with other locations outside (12.9% vs 6.4%; p = 0.030). CIL of interest was a predictor of intracranial bleeding (p = 0.033; OR: 2.17; 95% CI: 1.06 to 4.42).

Conclusion

The CIL of head injury is a predictor of intracranial lesions among geriatric patients with traumatic brain injury. Physicians should be aware of this association when assessing elderly patients with head injuries. More studies are needed to develop a clinical management tool incorporating CIL to guide the diagnosis of TBI in this population.

Keywords:

• cutaneous impact location
• traumatic brain injury
• TBI
• geriatric TBI

Abbreviations

95% CI, 95% Confidence Interval; CIL, cutaneous impact location; CT, computed tomography; DOACs, direct oral anticoagulants; ED, emergency department; EMS, emergency medical services; GCS, Glasgow Coma Scale; IQR, interquartile range; LMWH, low molecular weight heparin; OR, odds ratio; ROC, Receiver operating characteristics; RR, relative risk; TBI, traumatic brain injury.

Data Sharing Statement

The dataset collected during the study is available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

Patients have signed the necessary informed consent to the processing and use of health data for the purpose of this study and publication. The study protocol was approved by the Ethics Committee of Louis Pasteur University Hospital in Kosice, Slovakia (code of approval: 2020/EK/12086), and confirmed that all ethical requirements were respected and followed herein, including the adherence to ethical standards according to the Declaration of Helsinki (1964) and its later amendments.

Consent for Publication

All authors have given consent.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest in this work.

Additional information

Funding

This study was not supported by any funding.