Traumatic brain injury in elderly people attending a Hospital Emergency Department: A descriptive study focusing on fall risk medication

• Autores: Montserrat Alonso, Iñigo Gorostiza Ormaetxe, María Ángeles Acha, Lourdes Alcedo, Mónica Ibarrola, I. Loizaga Díaz, Mirari Zarrabeitia, Mikel Martínez Ortiz de Zárate
• Localización: European journal of clinical pharmacy: atención farmacéutica, ISSN 2385-409X, Vol. 20, Nº. 2, 2018, págs. 79-87
• Idioma: inglés
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• Resumen

  • Objectives: Traumatic brain injury due to falls accounts for a considerable number of attendances to the Emergency Department and leads a high morbidity. This study aimed to characterize traumatic brain injury in elderly patients, determining their causes, clinical management, consequences and related costs; and to identify associated risk factors, especially in relation to medication. Method: Observational study including all patients aged >75 attended for traumatic brain injury during a year at the Emergency Department in Basurto University Hospital. Data was retrieved from electronic health records on: demographic characteristics, cause of the injury, comorbidities, polypharmacy, patient status on admission, laboratory tests and imaging, length-of-stay, destination on discharge and costs. Results: A total of 859 patients were included (70.9% women, mean age 84.6 years). The cause of the injury was a fall in 83.1% of cases. The great majority of injuries were classified as mild, 96.8% obtaining a Glasgow Coma Score of 15. Almost three-quarters (72.1%) of patients were on multiple medications, taking a mean of 6.5 medications (SD: 3.2). Overall, 81.8% were taking at least one high fall-risk drug and 62.2% were taking a drug considered inappropriate by the STOPP criteria. The risk of hemorrhage was higher in patients who were taking anticoagulants (OR = 2.22; 95% CI: 1.14-4.19) and antiplatelets (OR = 1.74; 95% CI: 0.95-3.21). Total costs were €564,951; almost half of these costs (47.5%) were attributable to patients admitted to hospital wards. Conclusions: Most patients attended for traumatic brain injury associated with falls are on polypharmacy, including fall-risk drugs and anticoagulants/antiplate-lets that increase morbidity, so medication reviews should be conducted in coordination with primary care