Older men at greater risk for skull fracture after blunt head trauma

Men aged 65 years and older had a significantly higher rate of skull fracture compared with women after blunt head trauma, mostly because of falls, according to a study from The American Journal of Emergency Medicine.

“As the population continues to grow older and stay active for longer, the percentage of geriatric traumatic injuries has subsequently increased,” Scott M. Alter, MD, MBA, associate professor of emergency medicine at Florida Atlantic University Schmidt College of Medicine, and colleagues wrote. “With the increase of traumatic injuries among the geriatric community, it is important to reassess the consequences of these injuries and identify at-risk populations.”

To determine skull fracture risk as a result of head trauma in older men vs. women, researchers conducted a prospective cohort study at two level-one trauma centers in southeast Florida. They included 5,402 individuals aged 65 years and older (44% men; 90% white; mean age, 81.1 years and 82.8 years for men and women, respectively) who went to the emergency department for head trauma between August 2019 and August 2020. All participants underwent a head CT scan.

Research assistants performed chart reviews to acquire data on sex, race, ethnicity, mechanism of injury and head CT results. Mechanism of injury was determined by attending physician notes and included assault, bicycle accident, blunt injury, fall, motor vehicle accident, struck pedestrian and superficial injury.

The primary outcome of interest was skull fracture rate between sexes, also considering mechanism of injury and race/ethnicity.

Results showed that 4,612 (85%) of reported head injuries were due to falls, and 199 patients (3.7%) were diagnosed with skull fractures, most of whom were men (4.6% vs. 3%; OR = 1.5, 95% CI: 1.2–2.1). This trend was evident regardless of race/ethnicity or mechanism of injury.

Further, men had higher rates of skull fractures for any mechanism of injury, although most were due to a fall (OR = 1.3, 95% CI: 1.0-1.8) or motor vehicle crash (OR = 3.1, 95% CI: 0.8-11.8).

“Although fall prevention education can be addressed in the primary care setting or at assisted living facilities, the emergency department could also represent an opportunity to educate patients and to prevent future death and disability from falls in this population,” Alter said in a related release.

Reference:

• Men over 65 at greater risk than women of skull fractures from falls. https://www.fau.edu/newsdesk/articles/skull-fractures-fall-study. Published March 8, 2023. Accessed March 13, 2023.