Management of older adults after mild head trauma in an oral and maxillofacial surgery clinic

Key summary pointsAimTo determine the intracranial pathologies and treatment outcome after mild traumatic brain injury (mTBI) in patients aged >= 65 years referred to a clinic for oral and maxillofacial surgery.FindingsAcute and delayed intracranial hemorrhage and mortality rates are low in older patients after mTBI. Factors that increase the risk of intracranial complications are a decreasing Glasgow Coma Scale score, loss of consciousness, amnesia, cephalgia, somnolence, dizziness, and nausea. These findings may be useful for indicating a repeat CT scan.MessageTriage guidelines on screening and management of older patients with mTBI must be revised to improve patient outcomes. PurposeThe primary aim was to determine the incidence of intracranial hemorrhage (ICH) after mild traumatic brain injury (mTBI) in patients aged >= 65 years. The secondary aim was to identify risk factors for intracranial lesions and evaluate the need for in-hospital observation in this age group.MethodsThis observational retrospective single-center study included all patients aged >= 65 years who were referred to our clinic for oral and plastic maxillofacial surgery following mTBI over a five-year period. Demographic and anamnesis data, clinical and radiological findings, and treatment were analyzed. Acute and delayed ICH and patient outcomes during hospitalization were evaluated using descriptive statistical analysis. A multivariable analysis was performed to find associations between CT findings and clinical data.ResultsA total of 1,062 patients (55.7% male, 44.2% female) with a mean age of 86.3 years were included in the analysis. Ground-level fall was the most frequent cause of trauma (52.3%). Fifty-nine patients (5.5%) developed an acute traumatic ICH, and 73 intracerebral lesions were radiologically observed. No association was detected between ICH rate and antithrombotic medication (p = 0.4353). The delayed ICH rate was 0.09% and the mortality rate was 0.09%. Significant risk factors for increased ICH were a Glasgow Coma Scale score of < 15, loss of consciousness, amnesia, cephalgia, somnolence, dizziness, and nausea according to multivariable analysis.ConclusionOur study showed a low prevalence of acute and delayed ICH in older adults with mTBI. The ICH risk factors identified here should be considered when revising guidelines and developing a valid screening tool. Repeat CT imaging is recommended in patients with secondary neurological deterioration. In-hospital observation should be based on an assessment of frailty and comorbidities and not on CT findings alone.

Automated summary

The aim of this study was to determine the incidence of intracranial hemorrhage (ICH) and treatment outcome after mild traumatic brain injury (mTBI) in patients aged >= 65 years. The study found that older patients had low rates of acute and delayed intracranial hemorrhage and mortality after mTBI. Risk factors for intracranial complications included a decreasing Glasgow Coma Scale score, loss of consciousness, amnesia, cephalgia, somnolence, dizziness, and nausea.