Prevalence and presenting symptoms of intracranial hemorrhage in older adults presenting with subacute head injuries in a level-2 trauma center: A retrospective cohort study.

Abstract

Due to our ageing population, the incidence of subacute head injuries such as chronic subdural hematoma is increasing. As current clinical decision rules regarding CT imaging are in context of acute head injuries, it remains unclear what presenting symptoms of subacute (>48 h after initial trauma) head injuries in older adults are relevant for clinical practice. To aim of this study is to describe the prevalence of traumatic intracranial hemorrhage in older adults presenting to the emergency department with subacute head injuries and identify symptoms associated with traumatic ICH. This retrospective cohort included patients > 65 years who underwent CT imaging for subacute head injuries in the emergency department of a single level-2 trauma center between 2020-2024. The primary outcome was traumatic ICH. Secondary outcomes included hospital length of stay, anticoagulation reversal, neurosurgical intervention, and 90-day mortality. 374 patients were included, with a mean age of 79.1 (SD 6.7) and 170 (54.5%) were male. 62 (16.6%) patients had ICH, of which 40 (68%) were large lesions with mass effect or epidural hematoma. In patients with ICH, median hospital length of stay was 7 (IQR 4- 11) days, 8/18 (44%) anticoagulated patients received pharmacological reversal, 25 (40%) received neurosurgical intervention, and five (8%) died within 90 days. Prior CT images were available from < 48 h post-injury for 20 (32%) patients with ICH, of which 14 (70%) already reported ICH. Symptoms associated with ICH were headache (aOR 2.90, 95%CI 1.60-5.24), vomiting (aOR 2.57, 95%CI 1.25-5.28), focal neurological deficits (aOR 5.82, 95%CI 2.98-11.37), and gait disorders (aOR 3.54, 95%CI 1.94-6.45). ICH was more common in patients presenting > 30 days (aOR 4.19, 95%CI 1.99-8.82). The prevalence of traumatic intracranial hemorrhage is relatively high in older adults with subacute head injuries, which despite a high rate of neurosurgical interventions has a generally favorable prognosis. Presenting symptoms such as headache, vomiting, neurologic deficits and gait disorders are often evident. These findings may also argue for a wait-and-see approach in older adults with acute head injuries.