Facial Fracture–Associated Intracranial Hemorrhage in the Elderly Population

• Published in: The American surgeon 2019-07, Vol.85 (7), p.315-317
• Main Authors: Dobitsch, Andrew A., Oleck, Nicholas C., Mansukhani, Priya A., Halsey, Jordan N., Le, Thuy-My T., Hoppe, Ian C., Lee, Edward S., Granick, Mark S.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anticoagulants; Brain; Brain injury; Cardiovascular disease; Complications; Demographics; Demography; Diabetes; Facial Bones - injuries; Fatalities; Female; Fibrillation; Fractures; Geriatrics; Head injuries; Hemorrhage; Hospitals; Humans; Hypotension; Hypoxia; Injuries; Intensive care; Intracranial Hemorrhages - etiology; Male; Mortality; Older people; Patients; Plastic surgery; Population; Risk Factors; Severity of Illness Index; Skull Fractures - complications; Trauma; Traumatic brain injury
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481908500701

[...]increased longevity and improved functional capacity have led to more individuals in this demographic partaking in recreational activities that may predispose an individual to a fall.1 When geriatric patients present with facial fractures, they frequently exhibit higher mortality rates and severe associated injuries than younger patients. Because of their decreased cardiopulmonary reserve, geriatric patients sustaining related brain injuries are more susceptible to the dangers of hypoxia and hypotension, including death. After institutional review board approval was obtained, a retrospective chart review was performed for all facial fractures at University Hospital, Newark, NJ, from 2012 to 2014 based on ICD-9 codes. A retrospective chart review was performed, and information collected included patient demographics, fracture sites, concomitant injuries, length of hospital stay, critical complications, surgical procedures, concurrent medical conditions, and medications. Medical comorbidities requiring anticoagulation such as atrial fibrillation are prevalent in the elderly population, increasing the risk of severe hemorrhage in the setting of traumatic injury.4 Although a detailed medication list is often not readily available on presentation to the trauma bay, rapid screening tests may help identify patients who may be on anticoagulation therapy and, therefore, have an increased risk of ICH.