Risk factors for intracranial injuries in older adults with minor head trauma: how important is cutaneous lesion localization?

Older adults are susceptible to head trauma due to age-related changes. Even minor head trauma can lead to serious consequences. Our study aims to determine the impact of trauma location and characteristics on intracranial hemorrhage (ICH) in older adults. This is a retrospective study conducted on patients aged 65 years and older with minor head trauma or suspected head trauma who presented to the emergency department (ED) of a tertiary university hospital and underwent a brain computed tomography (CT) scan during the 5-year period between 2019 and 2023. Cutaneous lesions were defined as laceration, hematoma, swelling, erythema, and ecchymosis. A binary logistic regression analyzed factors affecting ICH, such as age, gender, glasgow coma scale (GCS), anticoagulant use, head lesion location, witnessed trauma, trauma location, alcohol use, smoking, nausea-vomiting, amnesia, and neurological deficits. A total of 1191 eligible patients were analyzed. Brain CT revealed no acute pathology in 93% (n = 1108), while ICH was detected in 4.8% (n = 57). 77.2% (n = 44) of ICH patients and 89.5% (n = 23) of isolated skull fracture patients had head lesions. The rate of head cutaneous lesions was significantly higher in patients with ICH or isolated skull fractures (p < 0.001). The risk of ICH was 31 times higher in those presenting with low GCS (95% CI 12.944–74.702, p < 0.001). Individuals with frontal, parietal, occipital, temporal, or multiple lesions face significantly higher risks of ICH than those without lesions (8, 26, 18, 22, or 44 times, respectively). Additionally, patients with neurological deficits are nine times more likely to experience ICH than those without (p < 0.001). Brain CT is an established practice in the ED for diagnosing older adults who present with minor or suspected head trauma. In addition to previously studied findings such as neurological deficit and decreased GCS, cutaneous lesion localization in the skull also increases the risk of ICH according to its region. More comprehensive and multicenter studies are needed to include this determinant in scoring systems.