Cutaneous Impact Location Predicts Intracranial Injury Among the Elderly Population with Traumatic Brain Injury

Marián Sedlák,1,2 Adonis Wazir,3 Aikaterini Dima,4 Jakub Gazda,5 Radoslav Morochovič1 1Trauma Surgery Department, Pavol Jozef Safarik University in Kosice, Faculty of Medicine & Louis Pasteur University Hospital, Kosice, Slovakia; 2Zachranna Sluzba Kosice, Kosice, Slovakia; 3Swansea University Medical School, Swansea, UK; 4South London and Maudsley NHS Foundation Trust, London, UK; 5 2nd Department of Internal Medicine, Pavol Jozef Safarik University in Kosice, Faculty of Medicine & Louis Pasteur University Hospital, Kosice, SlovakiaCorrespondence: Marián Sedlák, Pavol Jozef Safarik University in Kosice, Faculty of Medicine & Louis Pasteur University Hospital, Trauma Surgery Department, Kosice, Slovakia, Email marian.sedlak.md@gmail.comBackground: Traumatic brain injury (TBI) is one of the most common trauma-related diagnoses among the elderly population treated in emergency departments (ED). Identification of patients with increased or decreased risk of intracranial bleeding is of clinical importance. The objective of this study was to evaluate the implication of cutaneous impact location (CIL) on the prevalence of intracranial injury after suspected or confirmed TBI irrespective of its severity.Methods: This was a retrospective, single-center, descriptive observational study of geriatric patients aged 65 years and older treated for suspected or confirmed TBI in a trauma surgery ED. The primary outcome of the study was the assessment of a CIL of the injury and its association with the prevalence of intracranial lesions found on a head computed tomography scan.Results: Among 381 patients included in the analysis, the CIL of interest (temporo-parietal and occipital impacts) was present among 178 (46.7%) cases. Thirty-six (9.5%) patients were diagnosed with intracranial bleeding. The prevalence of intracranial bleeding was higher in the CIL of interest group compared with other locations outside (12.9% vs 6.4%; p = 0.030). CIL of interest was a predictor of intracranial bleeding (p = 0.033; OR: 2.17; 95% CI: 1.06 to 4.42).Conclusion: The CIL of head injury is a predictor of intracranial lesions among geriatric patients with traumatic brain injury. Physicians should be aware of this association when assessing elderly patients with head injuries. More studies are needed to develop a clinical management tool incorporating CIL to guide the diagnosis of TBI in this population.Keywords: cutaneous impact location, traumatic brain injury, TBI, geriatric TBI