Changes with aging make older patients vulnerable to blunt head trauma and alter the potential for injury and the injury patterns seen among this expanding cohort. High-quality care requires a clear understanding of the factors associated with blunt head injuries in the elderly. Our objective was to develop a detailed assessment of the injury mechanisms, presentations, injury patterns, and outcomes among older blunt head trauma patients. We conducted a planned secondary analysis of patients aged 65 or greater who were enrolled in the National Emergency X-Radiography Utilization Study (NEXUS) Head Computed Tomography validation study. We performed a detailed assessment of the demographics, mechanisms, presentations, injuries, interventions, and outcomes among older patients. We identified 3,659 patients aged 65 years or greater, among the 11,770 patients enrolled in the NEXUS validation study. Of these older patients, 325 (8.9%) sustained significant injuries, as compared with significant injuries in 442 (5.4%) of the 8,111 younger patients. Older females (1,900; 51.9%) outnumbered older males (1,753; 47.9%), and occult presentations (exhibiting no high-risk clinical criteria beyond age) occurred in 48 (14.8%; 95% confidence interval (CI) 11.1 to 19.1) patients with significant injuries. Subdural hematomas (377 discreet lesions in 299 patients) and subarachnoid hemorrhages (333 discreet instances in 256 patients) were the most frequent types of injuries occurring in our elderly population. A ground-level fall was the most frequent mechanism of injury among all patients (2,211; 69.6%), those sustaining significant injuries (180; 55.7%), and those who died of their injuries (37; 46.3%), but mortality rates were highest among patients experiencing a fall from a ladder (11.8%; 4 deaths among 34 cases [95% CI 3.3% to 27.5%]) and automobile versus pedestrian events (10.7%; 16 deaths among 149 cases [95% CI 6.3% to 16.9%]). Among older patients who required neurosurgical intervention for their injuries, only 16.4% (95% CI 11.1% to 22.9%) were able to return home, 32.1% (95% CI 25.1% to 39.8%) required extended facility care, and 41.8% (95% CI 34.2% to 49.7%) died from their injuries. Older blunt head injury patients are at high risk of sustaining serious intracranial injuries even with low-risk mechanisms of injury, such as ground-level falls. Clinical evaluation is unreliable and frequently fails to identify patients with significant injuries. Outcomes, particularly after intervention, can be poor, with high rates of long-term disability and mortality.

中文翻译：

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老年人头部钝挫伤：NEXUS II 损伤队列分析

随着年龄的增长而发生的变化使老年患者容易受到钝性头部外伤，并改变了这一不断扩大的人群中受伤的可能性和受伤模式。高质量的护理需要清楚地了解与老年人头部钝伤相关的因素。我们的目标是对老年钝性头部创伤患者的损伤机制、表现、损伤模式和结果进行详细评估。我们对参加国家紧急 X 射线摄影利用研究 (NEXUS) 头部计算机断层扫描验证研究的 65 岁或以上患者进行了计划的二次分析。我们对老年患者的人口统计、机制、表现、损伤、干预措施和结果进行了详细评估。在参加 NEXUS 验证研究的 11,770 名患者中，我们确定了 3,659 名年龄在 65 岁或以上的患者。在这些老年患者中，有 325 名 (8.9%) 受到严重伤害，而 8,111 名年轻患者中有 442 名 (5.4%) 受到严重伤害。老年女性（1,900 人；51.9%）的数量多于老年男性（1,753 人；47.9%），其中 48 人出现隐匿症状（没有表现出年龄以外的高风险临床标准）（14.8%；95% 置信区间 (CI) 11.1 至 19.1）受重伤的患者。硬膜下血肿（299 名患者中的 377 处隐蔽性病变）和蛛网膜下腔出血（256 名患者中的 333 处隐蔽性病变）是老年人群中最常见的损伤类型。地面坠落是所有患者（2,211 名；69.6%）、严重受伤患者（180 名；55.7%）和因受伤死亡的患者（37 名；46.3%）中最常见的受伤机制，但死亡率在经历从梯子坠落的患者中最高（11.8%；34 例中有 4 例死亡 [95% CI 3.3% 至 27.5%]）和汽车与行人事件（10.7%；149 例中有 16 例死亡 [95% CI 6.3%]）至 16.9%]）。在因受伤而需要神经外科干预的老年患者中，只有 16.4%（95% CI 11.1% 至 22.9%）能够回家，32.1%（95% CI 25.1% 至 39.8%）需要延长设施护理，41.8% （95% CI 34.2% 至 49.7%）因受伤死亡。老年钝性头部损伤患者即使有低风险的损伤机制（例如地面跌落），也面临着严重颅内损伤的高风险。临床评估不可靠，并且经常无法识别出严重受伤的患者。结果，特别是干预后的结果可能很差，长期残疾和死亡率很高。