• Xavier Dubucs, Éric Mercier, Valérie Boucher, Samuel Lauzon, Frederic Balen, Sandrine Charpentier, and Marcel Emond.
• Centre Hospitalier Universitaire de Québec, Université Laval Research Center, Axe Santé des Populations et Pratiques Optimales en Santé, D'Estimauville, Québec, Québec, Canada; Université Laval, Québec, Québec, Canada; Centre d'Epidémiologie et de Recherche en Santé des Populations, UMR 1295, Toulouse, France; Pôle Médecine d'Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
• J Emerg Med. 2024 May 1; 66 (5): e606e613e606-e613.

BackgroundMild traumatic brain injuries (TBIs) are highly prevalent in older adults, and ground-level falls are the most frequent mechanism of injury.ObjectiveThis study aimed to assess whether frailty was associated with head impact location among older patients who sustained a ground-level fall-related, mild TBI. The secondary objective was to measure the association between frailty and intracranial hemorrhages.MethodsWe conducted a planned sub-analysis of a prospective observational study in two urban university-affiliated emergency departments (EDs). Patients 65 years and older who sustained a ground-level fall-related, mild TBI were included if they consulted in the ED between January 2019 and June 2019. Frailty was assessed using the Clinical Frailty Scale (CFS). Patients were stratified into the following three groups: robust (CFS score 1-3), vulnerable-frail (CFS score 4-6), and severely frail (CFS score 7-9).ResultsA total of 335 patients were included; mean ± SD age was 86.9 ± 8.1 years. In multivariable analysis, frontal impact was significantly increased in severely frail patients compared with robust patients (odds ratio [OR] 4.8 [95% CI 1.4-16.8]; p = 0.01). Intracranial hemorrhages were found in 6.2%, 7.5%, and 13.3% of robust, vulnerable-frail, and severely frail patients, respectively. The OR of intracranial hemorrhages was 1.24 (95% CI 0.44-3.45; p = 0.68) in vulnerable-frail patients and 2.34 (95% CI 0.41-13.6; p = 0.34) in those considered severely frail.ConclusionsThis study found an association between the level of frailty and the head impact location in older patients who sustained a ground-level fall. Our results suggest that head impact location after a fall can help physicians identify frail patients. Although not statistically significant, the prevalence of intracranial hemorrhage seems to increase with the level of frailty.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

23 keywords...

hide…