TOPLINE:

In a meta-analysis of 17 studies, traumatic intracranial hemorrhage (ICH) was prevalent in nearly 7% of older adults with head injury from ground-level falls, with focal neurologic signs, head trauma, loss of consciousness, and male sex being strongly associated with an increased risk for traumatic ICH.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of 17 observational studies involving 22,520 patients (age, 65 years or older; 39.3% men) who presented to the emergency department (ED) with suspected or confirmed head trauma (Glasgow Coma Scale score ≥ 13) after ground-level falls.
• Participants had undergone head CT during initial ED visits or received systematic follow-up to rule out traumatic ICH.
• The main outcome was any traumatic ICH (new ICH or expansion of chronic hemorrhage) detected on head CT scans; secondary outcomes included the need for urgent neurosurgical intervention as well as the rates of hospital admission and in-hospital mortality.

TAKEAWAY:

• Traumatic ICH was prevalent in 6.8% of patients.
• Among patients with traumatic ICH, 8.0% required urgent neurosurgical intervention and the rates of hospital admission and in-hospital mortality were 36.8% and 1.5%, respectively.
• Focal neurologic signs (adjusted odds ratio [aOR], 4.4; 95% CI, 3.0-6.5), external signs of head trauma (aOR, 2.7; 95% CI, 2.1-3.5), loss of consciousness (aOR, 1.6; 95% CI, 1.2-2.1), and male sex (aOR, 1.4; 95% CI, 1.2-1.6) were associated with an increased risk for ICH.
• Preinjury anticoagulant use, preinjury single antiplatelet medication, reduced Glasgow Coma Scale scores from baseline, vomiting, and headache were not associated with traumatic ICH.

IN PRACTICE:

"This systematic review and meta-analysis identified several factors associated with an increased risk of traumatic ICH in older patients who sustained a head injury from a ground-level fall," the authors wrote. "These results suggested that anticoagulants may not be associated with an increased risk of traumatic ICH in this population," they added.

SOURCE:

The study was led by Xavier Dubucs, MD, MSc, Centre de recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada. It was published online on July 22, 2025, in the Annals of Emergency Medicine.

LIMITATIONS:

Small sample sizes, single-center designs, and high heterogeneity across studies may have reduced the explanatory strength of the study findings. Additionally, detailed ICH data and information about antiplatelet and anticoagulant adherence were lacking, potentially introducing bias into the interpretation of results.

DISCLOSURES:

One author reported receiving a scholarship from VITAM (Centre de recherche en santé durable) and Université Laval (Bourse D'Excellence de recherche sur le Vieillissement). The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.