Clinical and radiological predictors of significant intracranial injury in head trauma: A five-year retrospective analysis in Pakistani geriatric patients

Objective: To determine the clinical and radiological factors associated with significant intracranial injury in geriatric patients presenting with head trauma, and to determine the proportion of patients who underwent neurosurgical intervention after traumatic brain injury (TBI). Methodology: This retrospective cohort study included patients aged 60 years and older who presented with head trauma at the Department of Neurosurgery, Unit-I, Punjab Institute of Neurosciences, Lahore, Pakistan, between January 2021 and December 2025. Clinical, radiological, treatment, and outcome data were collected from hospital records. After descriptive analyses, the chi-square test was used to determine factors associated with significant intracranial injury in geriatric patients. Results: A total of 72 patients were included, with a mean age of 66.9±7.9 years, and 80.60% (58) were male. Road traffic accidents were the most common cause of injury (73.60%, 53), while almost half of the patients had mild traumatic brain injury. Polytrauma (χ² (1) = 9.125, p = 0.004), vomiting (χ² (1) = 4.967, p = 0.043), seizures (χ² (1) = 9.125, p = 0.004), multiple intracranial lesions (χ² (1) = 49.924, p < 0.001), and cerebral edema (χ² (1) = 7.049, p = 0.008) were significantly associated with intracranial injury. Overall, 15 patients (20.8%) required neurosurgical intervention. Conclusion: History of polytrauma, presence of vomiting, and seizures are significant clinical factors associated with significant intracranial injury, while on radiology, presence of midline shift and cerebral edema were significant radiological factors associated with significant intracranial injury. Patients who underwent neurosurgical intervention had a greater proportion of subdural hematoma and midline shift on radiology.