Golden Years, Hidden Dangers – Blunt Head Trauma in the Elderly
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This study demonstrated that patients 65 years and older with blunt head trauma are at high risk of significant traumatic brain injuries and poor outcomes even with low-risk mechanisms of injury such as ground level falls and no other high-risk criteria besides advanced age. These findings suggest routine head CT imaging may be helpful for elderly patients with head trauma as clinical assessment may not identify patients with significant pathology.
Source
Blunt Head Injury in the Elderly: Analysis of the NEXUS II Injury Cohort. Ann Emerg Med. 2024 Feb 9:S0196-0644(24)00003-9. doi: 10.1016/j.annemergmed.2024.01.003. Online ahead of print.
CAP Coverage – Beta Lactam Only?
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In patients hospitalized with non-severe community-acquired pneumonia (CAP), beta-lactam (BL) only antibiotic regimens have been shown to have increased mortality as compared to other first-line regimens.
Source
Comparative Effectiveness of First-Line and Alternative Antibiotic Regimens in Hospitalized Patients With Nonsevere Community-Acquired Pneumonia: A Multicenter Retrospective Cohort Study. Chest. 2024 Jan;165(1):68-78. doi: 10.1016/j.chest.2023.08.008. Epub 2023 Aug 11.
Grandma MIGHT Have Hit Her Head…CT or Not?
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Overall rates of intracranial hemorrhage (ICH) in patients >65 years of age with either definite or uncertain head trauma were found to be 11.4% and 1.7%, respectively, leading these authors to recommend head CT imaging on all geriatric patients presenting with possible head trauma.
New Meta-Analysis – Steroids Lower CAP Mortality
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This meta-analysis found a reduction in all-cause mortality in patients hospitalized with severe CAP who received adjunctive corticosteroid therapy.
Source
Efficacy and Safety of Corticosteroid Therapy for Community-Acquired Pneumonia: A Meta-Analysis and Meta-Regression of Randomized, Controlled Trials. Clin Infect Dis. 2023 Dec 15;77(12):1704-1713. doi: 10.1093/cid/ciad496.
The Real Risks of Boarding in the Emergency Department
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In this large, multicenter prospective cohort study in France, researchers found that patients ≥75 years who were admitted overnight boarding in the ED had higher rates of in-hospital mortality, length of stay, and adverse events.
Source
Overnight Stay in the Emergency Department and Mortality in Older Patients. JAMA Intern Med. 2023 Dec 1;183(12):1378-1385. doi: 10.1001/jamainternmed.2023.5961.
BP Wildly Varies With Wrong Cuff Size
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This randomized controlled trial demonstrated a clinically significant difference in blood pressure measurements when inappropriately sized BP cuffs were used on patients.
Grandma Broke Her Neck? Prevalence of C-Spine Injuries from Ground Level Fall Over 65 Years
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This systematic review found that the prevalence of cervical spine injuries in patients 65 years or older after a ground level or low-level fall was between 3.8-4.1%.
Source
Cervical spine injuries in adults ≥ 65 years after low-level falls - A systematic review and meta-analysis. Am J Emerg Med. 2023 May;67:144-155. doi: 10.1016/j.ajem.2023.02.008. Epub 2023 Feb 10.
Stop the Bleeding…of Unnecessary Care – Another Strike Against Delayed Head CT
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No significant difference in delayed intracranial hemorrhage (dICH) was seen in patients on antithrombotic (AT) medication vs. no AT among patients with repeat CT.
Source
Findings on Repeat Posttraumatic Brain Computed Tomography Scans in Older Patients With Minimal Head Trauma and the Impact of Existing Antithrombotic Use. Ann Emerg Med. 2022 Oct 31;S0196-0644(22)00580-7. doi: 10.1016/j.annemergmed.2022.08.006. Online ahead of print.
Do We Need Delayed Head CT for Anticoagulated TBI Patients?
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Patients ≥65 years on warfarin with head injury were found to have a significantly higher rate of delayed intracranial hemorrhage (dICH) compared to elderly on direct oral anticoagulants (DOACs) and those not on anticoagulation (AC).
Source
Delayed intracranial hemorrhage after head injury among elderly patients on anticoagulation seen in the emergency department. CJEM. 2022 Oct 15. doi: 10.1007/s43678-022-00392-z. Epub ahead of print.
Old Person + Delirium = Head CT
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Among patients ≥65 years who presented to the ED with delirium, confusion, or altered mental status, 15.6% had an abnormal head CT. Presence of neurologic deficit was a significant predictor for abnormal CT, but anticoagulation was not.
Source
Head Computed Tomography Findings in Geriatric Emergency Department Patients with Delirium, Altered Mental Status, and Confusion: A Systematic Review. Acad Emerg Med. 2022 Nov 4. doi: 10.1111/acem.14622. Online ahead of print.