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Acute Care/Hospitalization

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Men, young children, and elderly people are most likely to sustain traumatic brain injury from blunt head trauma

Significant traumatic brain injury (TBI), which occurs in 5 to 10 percent of all patients with blunt head trauma, can cause serious problems and death. Examples of TBIs include skull fractures, hematomas, diffuse cerebral edema, intraventricular hemorrhage, and multiple cerebral contusions. Among emergency department (ED) patients who underwent computed tomography (CT) for blunt head trauma at 21 hospital EDs, men, children younger than 10 years, and elderly people were most likely to have significant TBI. This information might help determine ED physicians' thresholds to use CT in patients of extreme ages.

Anatomic factors may play a prominent role in TBI in children. Children have larger head-to-body ratios that may allow more energy from a traumatic impact to be distributed to their head. Also, certain mechanisms of injury are unique to children and may increase the risk of TBI, such as child abuse. The increased risk of TBI in the elderly may be secondary to several factors. Stretching of bridging veins as a consequence of cerebral atrophy, and being on blood thinners (common in the elderly) may increase elderly risk of serious TBI associated with even minor blunt trauma. Also, the elderly are prone to falling, which is also associated with TBIs.

Age also plays a role in the type of injury sustained. For example, nearly half the children younger than 10 years with TBI had a skull fracture, but less than 20 percent of those older than 65 did. Similarly, intraparenchymal hemorrhages were exceedingly rare in children younger than 10 years. Epidural hematoma was much less common among the elderly, perhaps due to increased adherence of the dura mater to the skull with aging.

Finally, men were about 30 percent more likely to suffer a TBI than women, highlighting the public health problem of trauma in the male population. The study was supported by the Agency for Healthcare Research and Quality (HS09699).

See "Epidemiology of blunt head injury victims undergoing ED cranial computed tomographic scanning," by James F. Holmes, M.D., M.P.H., Gregory W. Hendey, M.D., Jennifer A. Oman, M.D., and others, in the March 2006 American Journal of Emergency Medicine 24, pp. 167-173.

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