Incidence of intracranial bleeding in seniors presenting to the emergency department after a fall: A systematic review. Issue 2 (February 2020)

• Record Type: Journal Article
• Authors: de Wit, Kerstin; Merali, Zahra; Kagoma, Yoan; Mercier, Éric
• Is Part Of: Injury. Volume 51:Issue 2(2020)
• Page Start: 157
• Page End: 163
• Publication Date: 2020-02
• Subjects: Seniors -- Falls -- Traumatic brain injury; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2019.12.036
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Falling on level-ground is the most common cause of traumatic intracranial bleeding. The number of seniors who present to emergency departments after a fall increases each year. Our systematic review found sparse, heterogeneous and generally low-quality research in this patient group. Our meta-analysis found that 1 in 20 seniors who present to an emergency department after a fall are diagnosed with intracranial bleeding. Abstract: Introduction: Seniors who fall are an increasing proportion of the patients who are treated in emergency departments (ED). Falling on level-ground is the most common cause of traumatic intracranial bleeding. We aimed to determine the incidence of intracranial bleeding among all senior patients who present to ED after a fall. Method: We performed a systematic review. Medline, EMBASE, Cochrane, and Database of Abstracts of Reviews of Effects databases, Google Scholar, bibliographies and conference abstracts were searched for articles relevant to senior ED patients who presented after a ground-level fall. Studies were included if they reported on patients aged 65 or older who had fallen. At least 80% of the population had to have suffered a ground-level fall. There were no language restrictions. We performed a meta-analysis (using the random effects model) to report the pooled incidence of intracranial bleeding within 6 weeks of the fall. Results: We identified eleven studies (including 11, 102 patients) addressing this clinical question. Only three studies were prospective in design. The studies varied in their inclusion criteria, with two requiring evidence of head injury and four requiring the emergency physician to have ordered a head computed tomography (CT). One study excluded patients on therapeutic anticoagulation. Overall, there was a high risk of bias for eight out of eleven studies. The pooled incidence of intracranial bleeding was 5.2% (95% CI 3.2–8.2%). A sensitivity analysis excluding studies with a high risk of bias gave a pooled estimate of 5.1% (95% CI 3.6–7.2%). Conclusion: We found a lack of high-quality evidence on senior ED patients who have fallen. The available literature suggests there is around a 5% incidence of intracranial bleeding in seniors who present to the ED after a fall.