RSNA 2016

Abstract Archives of the RSNA, 2016


ER237-SD-WEB5

Pattern of Head Injuries in the Elderly

Wednesday, Nov. 30 12:45PM - 1:15PM Room: ER Community, Learning Center Station #5



Awards
Student Travel Stipend Award

Kenedy A. Foryoung, MD, Hamden, DC (Presenter) Nothing to Disclose
Felix T. Nautsch, MS, BA, New Haven, CT (Abstract Co-Author) Nothing to Disclose
Xiao Wu, New Haven, CT (Abstract Co-Author) Nothing to Disclose
Ajay Malhotra, MD, Stamford, CT (Abstract Co-Author) Nothing to Disclose
Diego B. Nunez JR, MD, MPH, Boston, MA (Abstract Co-Author) Nothing to Disclose
PURPOSE

Head and cervical spine computed tomography (CT) are the workhorse modalities for the evaluation of neurologic trauma in the emergency setting. Knowledge of typical injury patterns and typical injury mechanisms as they occur in different age groups may help improve performance by guiding search patterns, key ancillary data given to the radiologist and possibly reformatting algorithms.

METHOD AND MATERIALS

CT studies of the brain and brain and cervical spine of adults performed in the Emergency Department between 2/15/2014 and 2/15/2015 were retrieved from the electronic medical records. For all studies with critical findings, the images, reports and associated medical record were manually reviewed.  Histories of trauma or possible trauma with findings of traumatic injuries by CT were included. The data was separated by Age into two groups aged above 65 and 18-64. We grouped fractures and hemorrhages by type and anatomic location. Collateral information such as anticoagulation status and additional history were manually retrieved. 

RESULTS

A total of 384 studies with patients above the age of 65 and 518 studies with patients aged between 18 and 65 with critical results were identified for manual review. Following preliminary manual review approximately 70% met inclusion criteria by history and findings in both age groups. 85% of the group aged above 65 suffered a traumatic fall and 37% were on anti-coagulation. The most common traumatic bleed above the age of 65 was an acute subdural bleed, which occurred 35% of the time. The predominant cranial area of fracture was the face in 30% of all studies above 65. High velocity mechanisms of injury in the elderly were present in only 6% of the cases. Diffuse axonal injuries, parenchymal hemorrhage and arterial epidural collections were rare.  While epidural and subarachnoid hemorrhage remained a relatively rare finding in the younger age group, the preponderance of subdural hemorrhages decreased to 23%.  Similarly, high velocity injury mechanisms occurred about 10% of the time and a second predominant mechanism of injury, assault, occurred 12% of the time.

CONCLUSION

The elderly suffer specific injury patterns closely associated with their typical mechanisms of injury and anti-coagulation state.

CLINICAL RELEVANCE/APPLICATION

Injury patterns after blunt trauma might be different in the elderly patients relative to younger population.