[Diagnostic algorithm for the management of patients ≥ 65 years with a mild traumatic brain injury in the emergency department].

BACKGROUND

Mild traumatic brain injury (TBI) following low-impact trauma, such as falls from ground level, frequently affects older patients in the emergency department. Due to the demographic change, an increase in this type of injury in emergency departments is to be expected. The aim of this study was to develop an evidence-based diagnostic algorithm for patients ≥ 65 years of age with mild TBI who present to the emergency department.

METHODS

Systematic reviews with literature searches in MEDLINE (English/German) and manual searches of references were conducted for three diagnostic questions. Studies were evaluated using the  Methodological index for nonrandomized studies. Data synthesis was performed using vote counting based on direction of effect and the evaluation of clinical influencing factors.

RESULTS

A database search yielded 52 studies involving 142,037 patients. For initial cranial imaging using cranial computed tomography (cCT), an approach based on six clinical influencing factors could be an alternative to routine imaging. In asymptomatic patients with no neurological abnormalities, neurological monitoring without standardized control cCT is conceivable; however, there are no reliable data available on the optimal design. The modalities of neurological monitoring need to be further investigated. The role of anticoagulation and antiplatelet treatment remains unclear.

CONCLUSION

The results form the basis for an algorithm for the diagnosis of mild TBI in older patients. The evidence-based design of neurological monitoring and the influence of anticoagulant medication require further research.