Cranial CT scans rarely result in neurosurgical transfers in older adults over 80 years with acute head injuries: A retrospective cohort study.

Abstract

Due to an ageing population and low threshold for imaging in older adults with acute head injuries, the resulting number of cranial CT scans continues to increase. While current clinical decision rules aim to identify all intracranial traumatic injuries, the clinical significance of these findings in older adults remains disputed. This study describes traumatic findings on CT imaging and neurosurgical care transfers of older adults with acute head injuries. This retrospective cohort included patients ≥ 65 years who received cranial CT imaging for an acute head injury in a single level-2 trauma center, without neurosurgical care available, between 2020-2024. Intracranial hemorrhage was classified as a minor or major lesion (i.e., with or without mass effect). The primary outcome measure, transfer rate to neurosurgical care, was compared between age groups 65-80 and > 80. Secondary outcomes included hospital length of stay, anticoagulation reversal, 30-day readmission, and in-hospital and 90-day mortality. In 4581 included CT reports, minor and major traumatic cranial lesions were found in 315 (6.9%) and 88 (1.9%) patients, respectively. The prevalence of traumatic findings was comparable between age groups. Five out of 45 patients aged > 80 with major lesions were transferred to neurosurgical care, compared to 15 out of 43 patients aged 65-80 (11.1% vs. 34.9%, p = 0.008). In univariate logistic regression, none of the patient baseline characteristics were significantly associated with neurosurgical transfer. There were no transfers reported in institutionalized and bedbound patients. Secondary outcomes did not differ between age groups, and 90-day mortality for patients with major lesions was 40.9%. While the prevalence of traumatic findings is comparable between older adults with an acute head injury aged 65-80 and > 80, the rate of neurosurgical transfers for major lesions is lower for patients aged > 80. Older adults with major lesions are at high risk of mortality, which may reflect restrictive management of traumatic intracranial lesions with increasing age and in patients with poor functional status.