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Volume 20 - Issue 2, March-April 2018
ORIGINAL
TRAUMATIC BRAIN INJURY IN ELDERLY PEOPLE ATTENDING A HOSPITAL EMERGENCY DEPARTMENT: A DESCRIPTIVE STUDY FOCUSING ON FALL RISK MEDICATION
ALONSO MONTSERRAT, GOROSTIZA IÑIGO, ACHA MARÍA ÁNGELES, ALCEDO LOURDES, IBARROLA MÓNICA, LOIZAGA IRUNE, MATEO CARMEN, ZARRABEITIA MIRARI, MARTÍNEZ MIKEL


Objectives: Traumatic brain injury due to falls accounts for a considerable number of attendances to the Emergency Department and leads a high morbidity. This study aimed to characterize traumatic brain injury in elderly patients, determining their causes, clinical management, consequences and related costs; and to identify
associated risk factors, especially in relation to medication.

Method: Observational study including all patients aged ≥75 attended for traumatic brain injury during a year at the Emergency Department in Basurto University Hospital. Data was retrieved from electronic health records on: demographic characteristics, cause of the injury, comorbidities, polypharmacy, patient status on admission, laboratory tests and imaging, length-of-stay, destination on discharge and costs.

Results: A total of 859 patients were included (70.9% women, mean age 84.6 years). The cause of the injury was a fall in 83.1% of cases. The great majority of injuries were classified as mild, 96.8% obtaining a Glasgow Coma Score of 15. Almost three-quarters (72.1%) of patients were on multiple medications, taking a mean of 6.5 medications (SD: 3.2). Overall, 81.8% were taking at least one high fall-risk drug and 62.2% were taking a drug considered inappropriate by the STOPP criteria. The risk of hemorrhage was higher in patients who were taking anticoagulants (OR = 2.22; 95% CI: 1.14-4.19) and antiplatelets (OR = 1.74; 95% CI: 0.95-3.21). Total costs were €564,951; almost half of these costs (47.5%) were attributable to patients admitted to hospital wards.

Conclusions: Most patients attended for traumatic brain injury associated with falls are on polypharmacy, including fall-risk drugs and anticoagulants/antiplatelets that increase morbidity, so medication reviews should be conducted in coordination with primary care.

ANTICOAGULANTS – ELDERLY PATIENTS – EMERGENCY DEPARTMENT – FALL RISK MEDICATION – POLYPHARMACY – TRAUMATIC BRAIN INJURY



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