Do Rates of Intracranial Hemorrhage Increase With Age Among Geriatric Patients With Fall-Related Head Trauma?

Falls are the leading cause of traumatic brain injury (TBI) in adults aged ≥65 years and are associated with intracranial hemorrhage (ICH) after blunt head trauma. To determine whether the incidence of acute ICH increases with advancing age among geriatric emergency department (ED) patients presenting after a fall.

This was a secondary analysis of the Geriatric Head Trauma Short-Term Outcomes Project (GREAT STOP), a prospective cohort study conducted at two Level I trauma center EDs over one year. Patients aged ≥65 years who sustained blunt head trauma from a fall from standing and underwent head CT imaging were included. Patients were stratified into three age groups: 65–<75, 75–<85, and ≥85 years. The primary outcome was acute ICH on initial head CT. Chi-square tests compared ICH rates across age groups. Multivariable logistic regression assessed the independent association between age and ICH after adjusting for clinically relevant confounders, including demographics, comorbidities, and anticoagulant or antiplatelet use.

A total of 5,425 patients met inclusion criteria (55.6% female). Age distribution was 65–<75 years (22.7%), 75–<85 years (34.2%), and ≥85 years (43.1%). The overall incidence of ICH was 7.9% and did not differ significantly by age group (7.9%, 8.3%, and 7.6%, respectively; p=0.657). Older age was associated with higher prevalence of comorbidities, including hypertension, cognitive impairment, atrial fibrillation, diabetes, and cancer (all p≤0.041), and a greater proportion of female patients (p<0.001). In multivariable analysis, age was not independently associated with ICH (adjusted odds ratio 0.99; 95% CI 0.98–1.01; p=0.105).

Among geriatric ED patients presenting after a fall with blunt head trauma, advancing age was not independently associated with acute ICH. These findings suggest that chronological age alone should not be used as a surrogate for ICH risk and highlight the importance of individualized risk assessment in older adults with head injury.