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Head Injury Alerts: A Retrospective Study on the risk of intracranial bleed among elderly patients presenting after falls while on anticoagulation vs antiplatelet therapy
Meagan Kozhimala
*General Surgery, Waterbury, New Haven, CT
Introduction: Trauma is the fifth leading cause of death amongst the elderly population, those > 65 years old. It has
been shown that having a tiered system for trauma activation improves efficiency and patient outcomes. Our
institution implemented a 3-tier trauma activation system in 2017, for which the third tier involved “head injury
alerts” for patients > 65 y.o., on anticoagulation or antiplatelet therapy who had a head strike. The number of these alerts have steadily increased over the years due to the aging population. The activation requires an Emergency Department attending and surgical resident at the bedside within 5 minutes and CT scan of head within 15 minutes of arrival unless
deemed unsafe or unnecessary by the provider. This study sought to evaluate the realative rate of head bleeds for patients > 65 y.o on antiplatelet therapy relative to those on anticoagulation following headstrike.
Study Design: A retrospective chart review was performed on all patients from 2017 to 2023 who presented as a head injury alert in the emergency department and were evaluated by the surgery team. Patients were between 65 to 110 years old, on anticoagulation or antiplatelet therapy and had a head strike after a fall. Information on demographics, medication, presenting signs and symtpoms, imaging results, mechanism of injury, and patient outcome were collected.
All patient information was collected in a single, one-time chart review and de-identified.
Results: A total of 1,190 patients presented to the Emergency Department for a head injury alert between 2017 and 2023. Of these 46.3% (n=551) were Male and 53.7% (n=639) were Female (p=0.72). Of all patients who presented, only 5.7% (n=67) were found to have head bleeds. This composed 5.3% (n=29) of the Male cohort and 5.9% (n=38) of the female cohort. When comparing anticoagulation versus antiplatelet therapy for all ages, there was a significant difference with antiplatelet therapy more likely to result in a head bleed compared to anticoagulation therapy ( OR 2.09 (95% CI 1.19-3.67, p=0.01).
Conclusion(s): Overall, there were more female patients who fell as well as developed head bleeds which matched prior studies data on falls in the elderly population, though this did not reach significance in this study . Patients were significantly more likely to develop head bleeds after a fall when on antiplatelet medication compared to those on anticoagulation medication.Limitations include this being a retrospective study which excluded patient on multiple antiplatelet/anticoagulant or a combination of antiplatelet and anticoagulation.
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