Risk Factors for Traumatic Intracranial Hemorrhage in Older Adults Sustaining a Head Injury in Ground-Level Falls: A Systematic Review and Meta-analysis - 23/07/25
, Véronique Gingras, MD d, Valérie Boucher, MSc a, Pierre-Hugues Carmichael, MSc e, Marianne Ruel, MSc f, Kerstin De Wit, MD, MSc g, h, Keerat Grewal, MD, MSc i, j, Éric Mercier, MD, MSc k, Pierre-Gilles Blanchard, MD, PhD a, d, Axel Benhamed, MD, MSc a, d, Sandrine Charpentier, MD, PhD b, c, Marcel Émond, MD, MSc a, d, kAbstract |
Study objective |
Ground-level falls have become the leading cause of head injury in older adults. However, the risk factors for traumatic intracranial hemorrhage (ICH) in this population remain unclear. We aimed to identify risk factors for traumatic ICH in older patients who sustained a ground-level fall-related head injury presenting in the emergency department.
Methods |
A systematic search of Medline (Ovid), Embase (Embase.com), Cochrane Library (Wiley), CINAHL (EBSCO), and Web of Science Core Collection was performed on December 9, 2024. The studies' eligibility criteria included patients aged 65 years and over who consulted in an emergency department following a ground-level fall-related head trauma and who presented with a Glasgow Coma Scale score of at least 13. Head injury was defined as any trauma to the head, including the face. Odds ratios (ORs) for each risk factor were pooled from the selected studies. For each potential risk factor, a random-effects model was used to compare the risk of traumatic ICH between patients with and without the risk factor. We restricted sensitivity analyses to studies providing adjusted odds ratios (AORs) and high-quality studies according to the Newcastle-Ottawa quality assessment Scale (defined as Newcastle-Ottawa quality assessment Scale score ≥7).
Results |
A total of 17 observational studies involving 22,520 patients were included in this systematic review with meta-analysis. Seven were prospective (11,501 individuals), and 8 were multicenter studies (14,376 individuals). The prevalence of traumatic ICH was 6.8% (95% confidence interval [CI]: 6.5 to 7.2), occurring in 1,538 patients. Among patients with traumatic ICH, urgent neurosurgery intervention prevalence was 8.0% (95% CI: 5.0 to 12.0). The unadjusted ORs indicate that the risk factors of traumatic ICH were suspected open or depressed skull fracture (OR: 10.9 [95% CI 6.4 to 18.7]), signs of basal skull fracture (OR: 4.7 [95% CI 3.4 to 6.5]), reduced baseline Glasgow Coma Scale score (OR: 4.0 [95% CI 3.4 to 4.7]), focal neurologic signs (OR: 3.8 [95% CI 3.2 to 4.5]), seizure (OR: 3.2, [95% CI 1.5 to 7.0]), vomiting (OR: 2.7 [95% CI 2.1 to 3.5]), amnesia (OR: 2.4 [95% CI 2.0 to 3.0]), loss of consciousness (OR: 2.3 [95% CI 1.9 to 2.8]), headache (OR: 2.1 [95% CI 1.6 to 2.9]), external sign of head trauma (OR: 2.0 [95% CI 1.7 to 2.3]), male sex (OR: 1.5 [95% CI 1.3 to 1.6]), chronic kidney disease (OR: 1.4 [95% CI 1.0 to 1.9]), preinjury single antiplatelet (OR: 1.2 [95% CI 1.0 to 1.3]), and dual antiplatelet medication (OR: 2.3 [95% CI 1.5 to 3.5]). Preinjury anticoagulant was not a significant risk factor (OR: 0.8 [95% CI 0.7 to 1.0]).
Based on AOR, only focal neurologic signs (AOR: 4.4 [95% CI 3.0 to 6.5]), external sign of head trauma (AOR: 2.7 [95% CI 2.1 to 3.5]), loss of consciousness (AOR: 1.6 [95% CI 1.2 to 2.1]), and male sex (AOR: 1.4 [95% CI 1.2 to 1.6]) remained associated with traumatic ICH.
Conclusions |
This study identified risk factors for traumatic ICH that can be recognized in older patients presenting in the emergency department for a ground-level fall-related head injury. Based on these findings, there is a need for future prospective studies to evaluate potentially avoidable head computed tomography scans in this population.
Le texte complet de cet article est disponible en PDF.Keywords : Ground-level fall, Head injury, Older patients, Traumatic brain injury, Neuroimaging
Plan
| Please see page XX for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Timothy F. Platts-Mills, MD, MSc. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: XD: methodology (equal), investigation (lead), data analysis (equal), writing—original draft (lead); writing—review & editing (equal). VG: investigation (equal), data analysis (equal), writing—review & editing (supporting). VB: project administration (equal); writing—review & editing (equal); PC: methodology (lead); data analysis; visualization (lead); writing—review & editing (equal); MR: resources (lead), methodology (supporting); data analysis (equal); KdW, KG: methodology (equal), writing—review & editing (equal); ÉM, PB, AB, SC: writing—review & editing (supporting), review & editing (supporting). MÉ: methodology (equal), investigation (equal), writing—original draft (supporting); writing—review & editing (equal), review & editing (lead). All authors have read and approved the submitted manuscript and it has not been submitted elsewhere nor published elsewhere in whole or in part. All authors meet the criteria for authorship stated in the international committee of Medical Journal Editors. Xavier Dubucs takes responsibility for the paper as a whole. |
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| Data sharing statement: Data are available on reasonable request to xavier.dubucs@gmail.com, after review of proposed study protocol by protocol and publications committee. |
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| Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). XD received a scholarship from VITAM (Centre de recherche en santé durable) and Université Laval (Bourse D’Excellence de recherche sur le Vieillissement). The funder had no role in the design, data collection, data analysis, and reporting of this study. The authors have declared that no competing interests exist. |
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| Trial registration number: PROSPERO database (CRD42023478239) |
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