J S Batchelor
Central Manchester Foundation Trust, UK
Title: Risk factors for intracranial haemorrhage in elderly patients with blunt head trauma
Biography
Biography: J S Batchelor
Abstract
Falls in the elderly are a common problem with an ever aging population. Head injury causing intracranial haemorrhage from a fall from standing is the major cause of mortality in the elderly age group. A meta-analysis by Batchelor et al. (2012) studied the effect of warfarin on mortality in patients with blunt head trauma. Eleven papers were identified, which met the criteria for the meta-analysis. Despite the heterogeneity between the studies (Q test: 27.421, 10 DF, P=0.002), the fixed effects model was the preferred model based on the fact that 10 out of the 11 studies had an odds ratio greater than one. The results showed that warfarin anticoagulation increases the mortality from blunt head trauma by an odds ratio of 2.008 (95% CI 1.634 - 2.467). The risk of intracranial haemorrhage from blunt head trauma in patients on aspirin agents is approximately 1.5 and the mortality is OR =2.435 (95% CI: 0.637-9.314). The result is not statistically significant and the level of evidence for this is poor. Previous investigators have published case series advocating the use of platelet transfusions in patients with blunt head trauma with intracranial haemorrhage who are taking antiplatelet agents. The evidence for this approach is poor. Desmopressin may be the preferred option. This paper aims to discuss these areas in more detail.