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

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Key summary points

AbstractSection Aim

To 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.

AbstractSection Findings

Acute 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.

AbstractSection Message

Triage guidelines on screening and management of older patients with mTBI must be revised to improve patient outcomes.

Abstract

Purpose

The 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.

Methods

This 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.

Results

A 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.

Conclusion

Our 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.

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Data availability

The datasets generated and analysed during the current study are not publicly available due to institutional restrictions, but are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors like to thank Bacon Editing® for language editing of this manuscript.

Funding

This study did not receive any kind of external funding.

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Authors and Affiliations

  1. Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany

    Andreas Sakkas, Mario Scheurer, Sebastian Pietzka, Frank Wilde & Marcel Ebeling

  2. Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, Ulm, Germany

    Andreas Sakkas, Sebastian Pietzka & Frank Wilde

  3. Medical Statistics and Biomathematics, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany

    Christel Weiß

  4. Institute for Diagnostic and Interventional Radiology, Ludwigshafen Hospital, Ludwigshafen, Germany

    Qasim Mohammad

  5. Department of Cranio-Maxillo-Facial-Surgery, Ludwigshafen Hospital, Ludwigshafen, Germany

    Oliver Christian Thiele & Robert Andreas Mischkowski

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  1. Andreas Sakkas
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  2. Christel Weiß
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  3. Mario Scheurer
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Corresponding author

Correspondence to Andreas Sakkas.

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Conflict of interest

The authors declare that they have no competing or financial interests, either directly or indirectly, in the products listed in the study. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical statement

This research was conducted in full accordance with the ethical standards of the institutional research committee as well as with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this non-interventional observational retrospective study, patient data were referenced with the understanding and written consent of the patient, and all data were also anonymized and de-identified prior to analysis. In the3 case of non-adults, written consent was given by one of the parents. Full compliance with data protection and safeguarding of data was ensured and no information which could identify the patients was collected. Reporting was based on the recommendations of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative [56].

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Sakkas, A., Weiß, C., Scheurer, M. et al. Management of older adults after mild head trauma in an oral and maxillofacial surgery clinic. Eur Geriatr Med 14, 603–613 (2023). https://doi.org/10.1007/s41999-023-00781-2

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