Risk Factors for Traumatic Intracranial Hemorrhage in Older Adults Sustaining a Head Injury in Ground-Level Falls: A Systematic Review and Meta-analysis
Bibliographic record
Abstract
STUDY OBJECTIVE: Ground-level falls have become the leading cause of head injury in older adults. However, the risk factors for traumatic intracranial hemorrhage (ICH) in this population remain unclear. We aimed to identify risk factors for traumatic ICH in older patients who sustained a ground-level fall-related head injury presenting in the emergency department. METHODS: A systematic search of Medline (Ovid), Embase (Embase.com), Cochrane Library (Wiley), CINAHL (EBSCO), and Web of Science Core Collection was performed on December 9, 2024. The studies' eligibility criteria included patients aged 65 years and over who consulted in an emergency department following a ground-level fall-related head trauma and who presented with a Glasgow Coma Scale score of at least 13. Head injury was defined as any trauma to the head, including the face. Odds ratios (ORs) for each risk factor were pooled from the selected studies. For each potential risk factor, a random-effects model was used to compare the risk of traumatic ICH between patients with and without the risk factor. We restricted sensitivity analyses to studies providing adjusted odds ratios (AORs) and high-quality studies according to the Newcastle-Ottawa quality assessment Scale (defined as Newcastle-Ottawa quality assessment Scale score ≥7). RESULTS: A total of 17 observational studies involving 22,520 patients were included in this systematic review with meta-analysis. Seven were prospective (11,501 individuals), and 8 were multicenter studies (14,376 individuals). The prevalence of traumatic ICH was 6.8% (95% confidence interval [CI]: 6.5 to 7.2), occurring in 1,538 patients. Among patients with traumatic ICH, urgent neurosurgery intervention prevalence was 8.0% (95% CI: 5.0 to 12.0). The unadjusted ORs indicate that the risk factors of traumatic ICH were suspected open or depressed skull fracture (OR: 10.9 [95% CI 6.4 to 18.7]), signs of basal skull fracture (OR: 4.7 [95% CI 3.4 to 6.5]), reduced baseline Glasgow Coma Scale score (OR: 4.0 [95% CI 3.4 to 4.7]), focal neurologic signs (OR: 3.8 [95% CI 3.2 to 4.5]), seizure (OR: 3.2, [95% CI 1.5 to 7.0]), vomiting (OR: 2.7 [95% CI 2.1 to 3.5]), amnesia (OR: 2.4 [95% CI 2.0 to 3.0]), loss of consciousness (OR: 2.3 [95% CI 1.9 to 2.8]), headache (OR: 2.1 [95% CI 1.6 to 2.9]), external sign of head trauma (OR: 2.0 [95% CI 1.7 to 2.3]), male sex (OR: 1.5 [95% CI 1.3 to 1.6]), chronic kidney disease (OR: 1.4 [95% CI 1.0 to 1.9]), preinjury single antiplatelet (OR: 1.2 [95% CI 1.0 to 1.3]), and dual antiplatelet medication (OR: 2.3 [95% CI 1.5 to 3.5]). Preinjury anticoagulant was not a significant risk factor (OR: 0.8 [95% CI 0.7 to 1.0]). Based on AOR, only focal neurologic signs (AOR: 4.4 [95% CI 3.0 to 6.5]), external sign of head trauma (AOR: 2.7 [95% CI 2.1 to 3.5]), loss of consciousness (AOR: 1.6 [95% CI 1.2 to 2.1]), and male sex (AOR: 1.4 [95% CI 1.2 to 1.6]) remained associated with traumatic ICH. CONCLUSIONS: This study identified risk factors for traumatic ICH that can be recognized in older patients presenting in the emergency department for a ground-level fall-related head injury. Based on these findings, there is a need for future prospective studies to evaluate potentially avoidable head computed tomography scans in this population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.027 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.020 | 0.034 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".