Knowledge gaps in the acute management of mild traumatic brain injury in older adults
Knowledge gaps in the acute management of mild traumatic brain injury in older adults
Mild traumatic brain injury (mTBI), often called “mild concussion,” is increasingly common among older adults. Managing these injuries can be challenging because older adults face different risks and complications after head trauma compared with younger patients. For example, they often use medications to prevent thrombotic events, are more likely to develop traumatic intracranial hemorrhage (tICH) even after mild injury, and frequently have other health problems that complicate recovery. Current guidelines do not always reflect these differences. As a result, some patients may receive more treatment than necessary, while others may not get the care they need.
In this thesis of Juliette Santing, several aspects of mTBI in older adults are investigated. By using national data, we have shown that the number of emergency visits and hospital admissions for head injuries is rising, in particular among older adults, mostly due to falls and traffic accidents. Blood tests as markers for brain injury severity, such as the biomarker S100B, are less reliable in older adults than in younger people. The effect of anticoagulant medications was also assessed, and it was found that newer drugs, called direct oral anticoagulants (DOACs), are generally safer than vitamin K antagonists (VKAs), as they reduce the risk of tICH and the need for related interventions. These drugs carry a similar risk of secondary deterioration compared with other antiplatelet drugs. In older patients, some types of traumatic brain abnormalities appear to be low-risk for secondary deterioration and may allow for earlier hospital discharge. A survey among doctors, however, showed that they are cautious about discharging older patients with traumatic brain abnormalities, given the lack of guidance in current guidelines.
Overall, this thesis highlights the need for personalized assessment and better guidance to aid doctors in making safe, informed decisions for older adults with mTBI, thereby improving both care and quality of life.